03-104300 •ECEIVED CONSTRUCTI�PERMIT APPLICATION
CITY OF �..� APPLICATION NUMBER: O3 - bati_3. ¢ Q - EP
Federal \Nay SEP 1 8 2003
APPLICATION NUMBER: - -
CITY OF FEDERAL WAY !APPLICATION NUMBER: - -
**The following is required information-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
I'.PROPERTY INFORMATION
SITE ADDRESS: / ) Dl S r�1 pr.), ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
11 PR07ECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING o'MMECHANICAL ❑ DEMOLITION
o ELECTRICAL 0 ENGINEERING MI RE PREVENTION SYSTEM
• -(5/--
PROJECT DESCRIPTION(Provide detailed description): ^ `- L- t ?- _ -- i �� e l
ArmairiK121,„„,0 -41-tordrIligseAC. . 4....411.01
PROJECT NAME:
CCt C,)L� ) r` 4'1k ( h1C ( J
., - , • PEOPLE INFORMATION . ,
PROPERTY OWNER: T NAME: (/ C ( C ■ TMETONEMAILING AD S(SEE r ADESS- c,ST .ZIP. 1 V _. 4
CONTRACTOR: NAME: ' DAYTIME PHONE: i
ADT SECURITY SERVICES, INC. L44-_ 6 ) 654 - _3103
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
841 POWELL AVE SW # 101 Renton, WA 98055 ( ) II
CITY OF FEDERAL WAY BUSINESS LICENSE N B _ FAX NUMBER: I
i - ( �/ �_' - A I (206 ) 654 - 2179
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of Card required) ADTSESI03205 09 / 25 /2005
APPLICANT: NAME: \i ) L-/ I DAYTIME PHONE:
ADT SECURITY SERVICES, INC, /7 f
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): t EVENING PHONE:
841 POWELL AVE SW # 101 Renton, WA 98055 ; - �!
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT o TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS: 1
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER Et APPLICANT ❑ CONTRACTOR I I
-I DETAILED BUILDING INFORMATION ,
EXISTING USE: 6 17\,( :( ; EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTIONY**
• /
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
. • PROJECT FLOOR AREAS 1
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH -
OTHER FLOORS(DESCRIBE)
DECK
GARAGE -
HOW MANY FLOORS?
TOTAL:
. .. - : i;> •'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)
BOILER(S) FIREPLACE INSERT(S) 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)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
• DISCLAIMER/SIGNATURE 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 Federal Way as to any claim(including costs,expenses,and attorneys'fees Incurred In the
investigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application.
-- r
/ 7
NAME TITLE: Tom Estep ,,,,,
� � � / - DATE: � ! / /� ( — 1
❑ PROPERTY OWNER ❑APPLICANT CONTRACTOR /
FOR':OFFICE USE ON.tlri d
❑,NEW- T t riffADDITION„ y 1p ALTERATIONV 1,0';REP,/IRt''"k;6TENAt(TgIMPROI/EMENTO , `:
.CENSUS CODE: fotor46 ;.? +1011:00.40001WIt'°iLOT§IZE' ,,t$K4"M,V,°N °c.r ry
;:ZONING DESIGNATIONS�"xr1�"r,R ,.;00401:410 iEBUILO"IIG S11E(.L ONL',1(7 '�''`0 �` .:0 NO .
a
=COMP PLAN DESIGNATION `-V.;;: t, x1`-w4r MMM BASIC•'PLAN?MI]YES 07 s1J NO,,
;SECTION ., TOWNSHIP,'' - 'RANGE ',` .1 ' `N "°
; EW ADDRESS REQUIRED?�:�.! ? ., DYES
_ ❑ NO
PLATTED LOT? ,.❑YES .❑;,NO 's �„�a t ;CHANGE OFfUSE? •,'`'m,0 YES �=L1'NO -'., .
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dWfederalway.com
Consstion Permit Fee Calculation Abet
*******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.
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 14.00 for each additional$10000 or fraction thereof,to and including
(3)$2,001.00 to$25,000.00 $2,000.00
(3)$90.00 for the first$2,000.00 plus$1600 for each additional$1,00000 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 additional$1,000.00 or 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$9.00 for each additional$1.000.00 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$7000 for each additional$1,000.00 or fraction thereof,to and
including$500,000.00
(7)$500,001.00 to$1,000,000.00
(7)$4,079.00 for the fist$500,000.00 plus$600 for each additional$1,000.00 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$4.50 for each additional$1,000.00 or fraction thereof.
Bold number Is the base fee for the specified Increment
iTa//c/recl under//ned number Is the fee Der addidona/soeclifecl Increment
PLUS: Add 65 percent of 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,commerdal 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)
_:_, .:: .. ;, _ _ _: ■ MECHANICAL-` . :_
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
IN FIRE PREVENTION SYSTEM
PROPOSED VALUATION: i
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
. ■ PLUMBING -.
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)