01-104032 •
RE E VED
. G OCT 1 8 2 ! CONSTRUCTION PERMIT APPLICATION
pT-iuV er APPLICATION NUMBER: O(- Loi' )c -
BU6LDING DEPT. APPLICATION NUMBER: _ -
GlIr -
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.
• PROPERTY INFORMATION
SITE ADDRESS: Si*SQ3-(1"/h4vE, S Zµo T(. ASSESSOR'S TAX/PARCEL#: 7 Q t L - Q Q .�o �03
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): zurtef Arr1C4-1£p
• PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING o MANICAL ❑ DEMOLITION
0 ELECTRICAL o ENGINEERING AFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): (_mo4-1 11Z.LX Ftger.l �
AS S►-Icwly
em-t PLAP-1 Vac H C w 1 a-ot-t'r SL s ITE
PROJECT NAME: ICAL_ OFFee fl-orrA .iAl-( UP,our ] IDR... 0.4 IV S
• PEOPLE INFORMATION /
PROPERTY OWNER: NAME: DAYTIME PHONE:
r''1E►DICAI._ !ZEAL. E—1 STE. Ttaitcres (4761 `gir, l9
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
105" GG zAL. 'Ay! Su M. 203/ KttZK, r-+tG; 94303
CONTRACTOR: NAME: DAYTIME PHONE:
Fl •S`tSTEr' •••-• T"' (253) 4333 -12.49
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
211 Fre4 -r1-AC,E 23P rre 13/ tF; wA 904-1 (Z53) 933 -12-48
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
19 $7 9 - D 22 1 Q 4 - Fa L- (253) /35.-0115
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
£ S e E. \t/ L 1 Q .8 1 • is / t / oL
APPLICANT: NAME: DAYTIME PHONE:
t,.rtot 4 1/.1/41 I2 ( p-t GQov1(,atr" GRAPrtst-o (zo6) 7a3
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
4501 S►-t t L.SH)LE. AV E 'uE, ,%)07 ( ) -7133
RELATT NSHIP TO PROJECT: FAX NUMBER:
ie'ARCHITECT ❑TENANT 0 OTHER(DESCRIBE): (��)^-�a� . sem'
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑APPLICANT Is'C:UNTRACTOR J;,w�a�e,►A0.i I.Sa6non.-kmit,.3.Cpm`
• DETAILED BUILDING INFORMATION
EXISTING USE: r"IE.' ICAL.. PW L . EXISTING BUILDING ASSESSED/APPRAISED VALUATION $6 14ZL.,$
PROPOSED USE: MC1ACAt.. 6VPICE PROPOSED VALUATION FOR IMPROVEMENTS: $ 41;313
SPRINKLERED BUILDING? r3X/S o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ NO
'X • 0
WATER SERVICE PROVIDER: 3'LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: z1 KEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PROJECT FLOOR AREAS
FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST
SECOND 2, 8-15 2, V
C
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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 o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ 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 daim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such claim),which ay be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such clai - out off,'reliance of the city,including its officers and employees,upon the accuracy
of the information su '.d to th: s art o . s application.
NAME/TITLE• i Q—
DATE: I n-0 I
o PROPER •WNER 'PPLICAN 0 CONTRACTOR
. N- • •
PROPOSED VALUATION: 64,31'5
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
$21.00+{ X$7.00/fixture}= (8) Estimated Permit Fee
Estimated Permit Fee
X .65 = (9)Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
Sub Total (Page one): Une(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10)= (11)
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $44.25 _#of Thermostats(First-$33.50;add-n-$10.50ea)
(First 1300 ft-$67.00;Each add=n 500 112-$21.50) _Service and feeder $72.25 _#of Low voltage fire or burglar alarms
Square Feet: First 2500 ft2-$38.75;Each add-n 2500 ft2-$10.50
_Each outbuilding or garage $28.00 MOBILE HOME/RV PARK Square Feet:
(Inspected with service) _#of service or feeders *Per WAC 296-46-910(5)(b)(i&ii)
_Each outbuilding or garage $44.25 (First service/feeder-$44.25;Add=n service/ _#of Signs(First sign-$33.50;addm sign
(Inspected separately) feeder-$28 each) $16.00 each)
_Progress inspection per 2 hr $33.50
_Swimming pool,hot tub,spa 67.00
_Yard Pole meter loops 44.25
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL
(Includes three units or more) Altered Service or Feeders
Service Feeder Amps Service or Add'n _0 to 200 $72.25
_Up to 200 amp $72.25 $21.50 Feeder _201-600 169.00
_201-400 amp 89.75 44.25 _0 to 100 $72.25 $44.25 _601 -1000 254.50
_401-600 amp 123.25 61.50 _101-200 89.75 56.25 _over 1000 282.75
_601-800 amp 158.00 84.25 _201-400 169.00 67.00 _#of circuits
_Over 800 amp 225.25 169.00 _401-600 197.00 78.75 (1-5 circuits-$56.25;Addrn circuits,$5 ea)
ALTERED SINGLE/MULTI FAMILY _601-800 254.50 107.25
(When inspected separately from the services.) _801-1000 310.75 129.75 Temporary Service
Service or Feeder _Over 1000 339.00 181.00 _0 to 60 $38.75
_0 to 200 amp $61.50 _Over 600 volts surcharge 56.25 _61-100 44.25
_201-600 amp 89.75 _Mast or meter repair. 61.50 _101 -200 56.25
_over 600 amp 135.25 _201-400 67.00
_Mast or meter repair 33.50 _401-600 89.75
_#of circuits _over 600 97.75
(1-4 circuits-$44.25;Add=rr c rcuits$5 ea)
If service is greater than 200 amp,a plan review is req d.Fee is 35%of permit fee+$56.25.Add=1 plan review for other submissions is$67.00/hr.
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
TOTAL COLUMN(D):
Total Column(D)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $56.25+ X.35=(13)
• DEMOLITION