03-103995CONSTRUCAN PERMIT APPLICATION
CITY OF �..�jG�Y�® PPLICATION NUMBER:
� - - _
Federal Way G Y PPLICATION NUMBER:
AUG 2 7 2003 PPLICATION NUMBER:
The following is required y information — Please print (in ink) or type**
Please note: Electri�a`�BI�t� fns and Engineering permits may require a separate application.
SITE ADDRESS:
ASSESSOR'S TAX /PARCEL #:
LEGAL DESCnIO OF C PROPERTY i T�A�SEPAj¢TE DESCRIPTI IF LENGTHY)- �
PR03ECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING o PLUMBING o MECHANICAL o DEMOLITION
o ELECTRICAL o ENGINEERING 1,RR'�PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT: I NAME:
MAILING ADDRESS GREET ADDRESS; CT�(Y, STATE; ZIP): EVENING PRME:
RELATIONSHIP TO PROJECT: j FAX NUMUtK:
o ARCHITECT o TENANT o OTHER ( DESCRIBE): ( I
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER ❑APPLICANT t3 CONTRACTOR
EXISTING USE:
PROPOSED USE:
EXISTING BUILDING ASSESSED/ APPRAISED VALUATION $
SPRINKLERED BUILDING? o YES o NO
WATER SERVICE PROVIDER: o LAKEHAVEN
SEWER SERVICE PROVIDER: o LAKEHAVEN
PROPOSED VALUATION FOR IMPROVEMENTS: $
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES
❑ HIGHLINE o TACOMA o PRIVATE (WELL)
❑ HIGHLINE o PRIVATE (SEPTIC)
❑ NO
"NEW RESIDENTIAL CONSTRUCTION ONL *
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING S . FT.
PROPOSED S . FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACE INSERTS) RANGE(S) MISC. ( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHERS) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINKS) WATER CLOSET(S) MISC. ( )
INTERCEPTORS) SUMP(S)
BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and
further, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
further agree to hold harmless the City of Fe de Way as to any claim (including costs, expenses, and attorneys' fees Incurred in the
Investigation and defense of such daim), wh1 ay be made by any person, Including the undersigned, and filed against the City of
Federal Way, but only where such claim arises ut of the reliance of the city, including its officers and employees, upon the accuracy
of the Information supplied to the city as a; p of this application.
NAME /TITLE:
❑ PROPERTY OWNER ❑
DATE: c);� ' c),
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063 -9718 • 253-661-4000 • FAX: 253- 661 -4129
www.cttvofederalway.com
Conduction Per Calculation
Permit Fee Calcu e
* * * * ** *PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CITY STAFF PRIOR TO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WILL NOT BE ACCEPTED! * * * * * **
Building, mechanical, and fire prevention system fees are based on the following schedule.
PLUS:
TABLE A
TOTAL VALUATION
FEE FACTOR
(1) $1.00 to $500.00
(1) $30.00
(2) $501.00 to $2,000.00
(2) $30.00 for the first $500.00 plus $4,00 for each additional $100,A0or
fraction thereof, to and including
$2,000.00
(3) $2,001.00 to $25,000.00
(3) $90.00 for the first $2,000.00 plus S18, 00 for each additional
$1, 000, or fraction thereof, to and
including $25,000.00
(4) $25,001.00 to $50,000.00
(4) $504.00 for the first $25,000.00 plus $13.00 for each additional51,000,00or
fraction thereof, to and
including $50,000.00
(5) $50,001.00 to $100,000.00
(5) $829.00 for the first $50,000.00 plus $900 for eadr additional
$1,000,A7 or fraction thereof, to and
Including $100,000.00
(6) $100,001.00 to $500,000.00
(6) $1,279.00 for the first $100,000.00 plus 5700 for eadr additional
SI.00t1,00 or fraction thereof, to and
including $500,000.00
m $500,001.00 to $1,000,000.00
(7) $4,079.00 for the fist $500,000.00 plus 56.00 for ead� additional
51,0010,00 or fraction thereof, to and
including $1,000,000.00
(8) $1,000,001.00 and up
(8) $7,079.00 for the first $1,000,000.00 plus S4,50 for ead�
addmonal $1000. or fraction thereof.
Bold number Is the base fee for the specified Increment
ltal/dzed unded/ned number /s the lee per addKlona /saedRed
Increment
Add bS percent ot the base building permit fee for plan review fee.
Add 25 percent of the base mechanical permit fee for mechanical plan review fee.
Add 15 percent of the base building permit fee for Fire District #39 surcharge, commercial only.
Add $4.50 for WA State Building Code Council, plus $2.00 per unit for duplex & above.
** Electrical, plumbing, and mechanical fees are calculated separately **
■ BUILDING
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee, (4)
Estimated Plan Review Fee: (5)
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee:
Estimated Plan Review Fee: (7)
Base Fee Number of Fixtures
$26.00+( X $9.00 /fixture) _ (8) Estimated Permit Fee
Estimated Permit Fee
X .65 = (9) Estimated Plan Review Fee
Miscellaneous Fixture Charge: (10)
Sub Total (Page one): Line(s) ( 1)+( 2)+( 3) +(4) +(5) +(6) +(7) +(8) +(9) +(10) = (11)