03-105475 RIFEIVED
DEC 1 g 2003 CONSTRUCT I ION PERMIT APPLICATION
CITY OF figi"*3/4•-•-i APPLICATION NUMBER: - L Q 1 - - i
Federal Way CITYOLD�NDERAL GDEPT.AY APPLICATION NUMBER:
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.
y ■ PROPERTY INFORMATION ,
SITE ADDRESS: I b�3 Vac-- "),Ad• % • 6 •NXe _5"ASSESSOR'S TAX/PARCEL #: t a l 0 Y - g / a (.p
9
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
•
1 PROJECT INFORMATION.--_-';',": :::
TYPE OF PROJECT(This application): o BUILDING 0 PLUMBING o MECHANICAL o DEMOLITION
o ELECTRICALL 0 ENGINEERINGGFIRE PREVENTION
SYSTEM
PROJECT DESCRIPTION(Provide detailed description): ft(Of Rel.& x• vv VviiiJ G-6i /
35-
PROJECT
sPROJECT NAME: MI6 KOV S
PEOPLE.INFORMATION r
PROPERTY OWNER: NAME: `^ DAYTIME PHONE:
Y-Sv\ 4-NVcS'Y�Meen PrE)pe �
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
� r
CONTRACTOR: NAME: • DAYTIME PHONE:
i 121tP0f F119-e P ± G11alA / 10/ . ; (Zs3 ) ,/20 - 2.2:10
MAILING ADDRESS(STREET ADDRESS;CITY,STATE.ZIP): I. EVENING PHONE:
1-c 104k\five E- —ra cu1MoL wif -1211 ( )
{ i
I CITY OF FEDERAL WAY BUSINESS UCENSE NUMBER: FAX NUMBER:
j_ - l l )
CONTRACTOR'S REGISTRATION NUMBER: q }� /� q f- I EXPIRATION DATE:
(copy of card required) j` a - 1 f L -1 _[ ; l) / `-- / o
APPLICANT:
N2AMEE::-v�- DAYTIME PHONE:
? t)1 Fq.e, 2 fecI-* •• (25-s) �2b
-22�d
MAILING (STREET
PHONE-
Ave12t-i24
E • wCLw.0 E w> 12t 4 ! ( )
RELATIONSHIP TO PROJECT: i FAX NUMBER:
o ARCHITECT a TENANT Xi OTHER(DESCRIBE): SI- 1at,-yr.ccD'— ( /z5 q Z Z - ryr SD
E-MAIL ADDRESS:
I �
CONTACT PERSON FOR THIS PROJECT: a PROPERTY OWNER ? ,APPLICANT ❑ CONTRACTOR
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
S. -- PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? o YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑YES O NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION co** •
NUMBER OF BEDROOMS: ESTIMATED 5' PRICE: $
.■;:PROJECT FLOOR .1 1111O1111111111111111111111
FLOOR EXISTING SQ. FT. PROPO, `. 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: a ELECTRIC ❑GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) a ELECTRIC a GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
" M;;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 daim),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 dty,including its officers and employees,upon the accuracy
of the Information supplied to the dty as a part of this application.
NAME/TITLE: _ fj�L DATE: /,;.?/i cf 16-3
a PROPERTY OWNER i APPLICANT a CONTRACTOR
FOR OFFICE,USE':ONLY :;
QNEW S 6 ADDITION ❑ALTERATION Mq REPAIRS EflTENANT IMPROVEMENT
CENSUS:CODE • .1 t* ::•.. f LOT SIZE
ZONING DESIGNATION a ,� .a� g�,� g-��i
�� BUILDING:SHELL UNLY7�.❑YE5,�;7❑NO � �,
COMP PLANNDESIGNATION 0 .: s ,�04 BASIC PLAN?,. p YES ❑`NO
SECTION „€ TOWNSHIP # :; RANGE ' NEW ADDRESS REQUIRED?E . ❑YES ❑ NO
'PLATTED LOT? 0 YES.'o NO A,
CHANGE OF USE7. 7- ,-_❑YES .. 0 NO ,
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000.FAX:253-661-4129
yww.cftyoffederalway.com
Con•ction Permit Fee Calculation .et
*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CITY STAFF PRIOR TO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMt'3UNTS 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 • 4I .r-.to...Ai i.n.l U.U 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$16.00 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 5/3.00/breach 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$100100 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$6.02 for each additional$7000.00 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 54.50 for each additional$1.000.111 or fraction thereof.
Bold number Is the base fee for the specified Increment
JYalldzed,underlined number Is the ler-LW f nal fled Incremen f
PLUS: Md 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 Coundl,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)
- = -<FIRE PREVENTION SYSTEM
PROPOSED VALUATION: l gm bD
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): tine(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)