03-104685 iv
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® ,/ CCs RUC I 1 N PERMIT APPLICATION
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CITY OFpl 1A ���'�..- ��t�t� ER: - �_ (225
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_ AL V�1A'=The follow' ation—Pleaseprint(in ink)or
��1�YC)4- F�.C�L��PZ. �s 5� � � type**
lot. Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
.-■,PROPERTY INFORMATION
SITE ADDRESS: 1928 South Seatac Mall ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
SeaTac Mall
- :III PROTECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING 0 HAHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGINEERINGFCf IRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide deta'ed description):
Replace existing fire alarm panel, add additioanl devices
PROJECT NAME: l H �
',.(- �1 C)t t
R PEOPLE INFORMATION
PROPERTY OWNER: NAME: i DAYTIME PHONE: /
SeaTac Mall ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: ( NAME:
DAYTIME PHONE:
ADT SECURITY SERVICES, INC. (206 ) 654 - .3103
MAILING ADDRESS(STREET ADDRESS;CITY.STATE,ZIP): i. EVENING PHONE:
841 POWELL AVE SW II 101 Renton, WA 98055 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE N B,51:6,- , ----5.--- FAX NUMBER:
z - L () , - i (206 ) 654 - 2179
CONTRACTOR'S REGISTRATION NUMBER: l
� IXPIRATION DATE:
(rovyorcard required) ADTSESI03205 09 / 25 /2005
APPLICANT: I NAME: j DAYTIME PHONE.
ADT SECURITY SERVICES, INC, � ( 206 ) 624 - 3103
MAIUNG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
841 POWELL AVE SW # 101 r )
Renton, WA 9805 I ( � -
RELATIONSHIP TO PROJECT: FAX NUMBER:
0 ARCHITECT o TENANT o OTHER( DESCRIBE): ( ) -
E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT 0 CONTRACTOR I
. "-■ DETAILED BUILDING INFORMATION _
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION ;_
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE o TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ON•
• rr
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
:`a 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 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) 0 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 daim(induding costs,expenses,and attorneys'fees Incurred In the
Investigation and defense of such claim),which- ay be made by any person,Including the undersigned,and filed against the City of
Federal Way,but only where such daim ari ut of the reliance of the dty,induding its officers and employees,upon the accuracy
of the Information supplied to the dty as of this application.
Tom Estep / f (-2N-
NAME/TITLE:
DATE: /
❑ PROPERTY OWNER ❑AP LICANTf 4 ONTRACTOR
FOR OFFICE,USE,O.NLY: I
CF+-„t:id 5! _aY. 43M� . s,1�{.,,, a�S'2i• i¢5'.4G3 v.:Y.:£ '
b NEW ;.%Ci'ADDIiION .0 ALTERATION , O REPAIR ,,; t a TENANT IMPROVEMENT ..
xCENSUS CODE''' "a�, °"s ' 41P, �.•. . SLOT;SIZE ° •,w;
ZONING DESIGNATION 4x'0, `al- ' , K”: BUILDING SHELL ONLY? a YES ❑ NO
COMP PLAN*SIGNATION '. ,_ AW!4 BASIC PLAN? p.;YES. ' 0 NO,r _
SECTION t r,. r I .., , .
c - .TOWNSFIIP ��_, ;;: RANGE riff NEW ADDRESS..REQUIRED?;"�,,���,: ❑YES: •❑ NO .
:CHANGE OFFUSE? :fir, ''`,p YES ''-❑ NO` 2 .
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cItyoffederaiway.com
ConAction Permit Fee Calculation meet
*******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$1 00.00 or 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$18.00 for each additional 51.000.00 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 St000,00or 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$9.0 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$100,000.00 plus$Z00 for each additional 11.000.00 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$6,00 for each additional$1.000.00or 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 additonal51.000.417 or fraction thereof.
Bold number Is the base fee for the specified Increment
italicized.underlined number Is the fee ver additionalsvedfied 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,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)
.... ■ 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)
- v FIRE PREVENTION SYSTEM .,
(1
PROPOSED VALUATION: 7;(
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 ft turns
$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 (gage one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10)_ (11)