01-102359 fr If
°ITY°• G CONSTRUCTION PERMIT APPLICATION
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APPLICATION NUMBER: Q / -�D L j _ - r)
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APPLICATION NUMBER: - -
APPLICATION NUMBER: -**The foTh wing is required information—Please print(in ink)or type**
Please note: Electrical, Fiieirvelttibtt'$iem' and Engineering permits may require a separate application.
• PROPERTY INFORMATION
�"�.. a � - 32 I'o - oo/
SITE ADDRESS: 4 110 ! �� ASSESSOR'S TAX/PARCEL#:
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERINGTgFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): 3 j.4 _ ,4 <e 1 .11 ♦ L /y-
i/' l/ L Z4.1 .10 t-
Wl No C / /lC
PROJECT NAME: AOP09iPAr-e.,..***:, T?/57 8i/TatS
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
34110 Avr s� .
CONTRACTOR: NAME: DAYTIME PHONE:
0
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MAILING ADDRESSt sssWWW[WW-�WWW///�(STREET ADDRESS; STATE,ZIP): EVENING PHONE.
:
/ 743 --/sr ( 5d) • S . ccJ,1 %134 ( )
CITY OF FEDERAL WAY BUSINESS UC SE NUMBER: > FAX NUMBER:
6 , tS c 6(. 2.A,60_ _ ) - con!
CONTRACTOR'S REGISTRATION NUMBER: EXPIRAT4' o
DATE:
(copy of card required) ' U A j D jS a
APPLICANT: NAME: DAYTIME
PHONE:
4• e / Kilp(ae / fiet 1 //p,//n)x.?
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7
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): VENING PHONE:
( ) i
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE)ej) 4(7/2 ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
C)0
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ tO00
SPRINKLERED BUILDING? El YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: • ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
.+.i
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**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
ON PROTECT FLOOR AREAS -
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND 67
THIRD L 0
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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Indicate number of each type of fixture
MECHANICAL
AIR HANDLING U S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
RANGGE(SS)
BOILER(S) FIREPLACE INSERT(S)
MISC.( )
COMPRESSOR(S) Fl • •CE(S)
DUCT(S) GAS PIP *o- ET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
BATHTUB(S) 'LAVATORY(S) URINALS)\ �� WATER HEATER(S)
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DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER-M----O ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
:` .- . �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 claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information supplied tolthe city�a�sa part of this application. /
NAME/TITLE: �fl� luaL1&i) s �(G$1 �� I�=t �I I�I L � I DATE: /Z D/
❑ PROPERTY OWNER ❑ APPLICANT LKC.ONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? 0 YES ❑ NO CHANGE OF USE? 0 YES 0 NO
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Construction Permit Fee Calculation Sheet
*******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)$24.25
(2)$501.00 to$2,000.00 (2);24.25 for the first$500.00 plus$3.27 for each additional$100.00 or fraction thereof,to and including$2,000.00
(3)$2,001.00 to$25,000.00 (3)$71.46 for the first$2,000.00 plus$15.00 for each additional$1,000.00 or fraction thereof,to and including
$25,000.00
(4)$25,001.00 to$50,000.00 (4)$403.61 for the first$25,000.00 plus$10.97 for each additional$1,000.00 or fraction thereof,to and including
$50,000.00.
(5)$50,001.00 to$100,000.00 (5)$664.35 for the first$50,000.00 plus$7.50 for each additional$1,000.00 or fraction thereof,to and including
$100,000.00.
(6)$100,001.00 to$500,000.00 (6)$1,025.55 for the first$100,000.00 plus$6.00 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)$3,337.23 for the fist$500,000.00 plus$5.09 for each additional$1,000.00 or fraction thereof,to and including
$1,000,000.00.
(8)$1,000,001.00 and up (8)$5,788.23 for the first$1,000,000.00 plus$3.91 for each additional$1,000.00 or fraction thereof.
Bold number is the base fee for the specified increment
Ilalicized,underlined number is the fee per additional specified 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)
,. ,■ FIRE PREVENTION SYSTEM . .
PROPOSED VALUATION: 3000.,
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)
Siih Tnt.74l rn,,, n.. . I inn(c\(11.r-O1-4(11-i-(41.i(C\+//`\+(71+(R1+(<11+(1fll = (111