03-104846 IV PC FF
El WED CONSTRUCIN PERMIT APPLICATION
CITY OF � '
." APPLICATION NUMBER: 03 - 111 k1 ' (7 -GO
Federal Way . f�. 2 4 2003 APPLICATION NUMBER: - -
%� `�',D; I FEDERAL APPLICATION NUMBER: - -
**The following s't`e i-mation—Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. 'I \
-<R .PROPERTY INFORMATION _ -__
SITE ADDRESS: 1GLC1 1C- fl vV yl s ASSESSOR'S TAX/PARCEL #: O ' c 109 - J I D.L
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): A-----Vt4-�
_ ,1 PROTECT INFORMATION .
TYPE OF PROJECT(This application): ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
0 ELECTRICAL a ENGINEERINGI FIRE PREVENTION`, SYSTEM
PROJECT DESCRIPTION(Provide detailed description): % _A ` re. ,, \ FE'r re - & . /A.
r- 7Y\ J Al 1 .
PROJECT NAME:/41/Ore 3 QA_
.. ? I PEOPLE INFORMATION`
PROPERTY OWNER: NAME: HA
DAYTIME PHONE
F :5 C vi--=6-1 IM rte'& ; ( ) -
;
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
i
CONTRACTOR: NAME:j) p �O; DAYTIMEAYPRONE::
Jj//� FT 2 - 'C`d e ' A. _a (ol )61, 4 -.a„)21.6
MAILING ADDRESS(STREETJ� A DRESS;/C/I��,STATE.ZIP): 74--(. 7016i-
/�) /�� EEVENING PHONE:
2y3
OF FEDERAL WAY BUSINESS UCENSE NUMBER: FAX NUMBER:
ii -ql-01-4/M-00 B0 ',- /.;4,it '"ik '- # L1 i ( )
CONTRACTOR'S REGISTRATION NUMBER: Q /� �J/� c I EXPIRATION DATE: (�� C,
(copy of card required) 1 A--1: _-'1_1 T S l q-{ C ` ; I C) / 5 / 7
APPLICANT: ( DAYTIME PHONE:
I ? i 'i l i 7,( k69dn7<_ (ate)1)-6 -aD-to
NG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
4 a -o YD? 4Ve 5 rAcamiA ( ) -
RELATI NSHIP TO PR IECT: j FAX NUMBER:
{
0 ARCHITECT ❑TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER ❑ APPLICANT o CONTRACTOR
. . --■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
I PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ it
"Q O
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES ❑ NO
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION O * 411
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROTECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.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 Value of Mechanical Work: $
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: o ELECTRIC ❑GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC o 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(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such claim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application.
C
NAME/TITLE: ()d erl )." C .r�(/� DATE: D P-y/e/
❑ PROPERTY OWNER XAPPLA T ❑CONTRACTOR
,,FOR.OFFICE USE ONLY:_=='
IE NEW�,f j ADDITION maxci ALTERATION; c REPAIR .
� �- � � ,O=TENANT IMPROVEMENT
"CENSUS CODE wo,„,'rAwim..: mmartLOT SIZE ga4- A-40 .=tWAA, -'?•-, W
if.t041#40:0k#:0:4-40.N.,MURAVAgnirriaBUILDING,SHELL ONLY? a YES n NO; ;- x
COMP PLAIVDESIGNATION , ,<ABASIC PLAN?` ,n YES ..,O NO
SECTIONS . TOWNSHIP x RANGE NEW ADDRESS REQUIRED? -. ❑YES ❑ NO
PLATTED LOT? ,:❑YES .;r❑,NOT " ”` ` ,.s CHANGE OF';USE? ,, p YES fl NO'
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000••FAX:253-6661-4129
www.citvoffederalwav,com
Consiction Permit Fee Calculation Set
*******PLEASE NOTE: ALL FEES MUST BE VERIFIEQLDY CITY STAFF PRIOR TO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WILL LOT 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$9.00 for each additional$100.00 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$1,000.00 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$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$7.00 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$6.00 for each additional 51,000.00 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$1.50 for each additional$1,000.00 or fraction thereof.
Bold number Is the base fee for the specified Increment
jla1/dzed uncle/lined number ls the lee peraddldpnalspedfed 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)
p ■ FIRE PREVENTION SYSTEM
PROPOSED VALUATION& l O C)0
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)