03-104299 ® IVES
�, R CONS 1 RUL 1 i0 � ERMIT APPLICATION
CITY OF �," APPLICATION NUMBER: _ _ - t 0 Ya• L l- _Fp
Federal Way SEP 1 s 2003 APPLICATION NUMBER: - -
APPLICATION NUMBER: - -
"!TY O
”The follo '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: - '' , �T 1(71 l-ThL _- /
� ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
3. s,11 PROJECT INFORMATION -
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING 0 MECHANICAL ❑ DEMOLITION
0 ELECTRICAL 0 ENGINEERING 1RE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
____________________A . \
L_\,C- C--A. --)-e_ 4L 'C-_--- Vr3fr fr)- 7---- 1,.0 72').-k-----.
1 K
PROJECT NAME: i 1 , C�_ )� J(H \ � X-[1(-�-_I
:.,M PEOPLE_INFORMATION : _ "I.::
i
PROPERTY OWNER: NAME: ! q i DAYTIME PHONE'
_( . ',1 (In x vir_.? 1 � ( )
MAILING ADDRESS(( EET ADDRESS; ,STATE,ZIP): J
...
11 _C
/ 1
CONTRACTOR: NAME: i DAYTIME PHONE
ADT SECURITY SERVICES, INC. ! (206 ) 654 - .3103
MAILING ADDRESS(STREET ADDRESS;CITY.STATE.ZIP): EVENING PHONE'
841 POWELL AVE SW // 101 Renton, WA 98055 ( ) -
COY OF FEDERAL WAY BUSINESS LICENSE N B R:
---i-� FAX NUMBER:
i Ct(i - LQ, ) C_- - L- I (206 ) 654 2179
CONTRACTORS REGISTRATION NUMBER: '
� IXPIRATION DATE:
(ropy of card required) ADTSESIO3205 i 09 / 25 /2005
APPLICANT: NAME: ! DAYTIME PHONE:
ADT SECURITY SERVICES, INC, (1),
/'() �� �
�- _ � (-28-6-)-62-4 _-- 3103- �
MAILING ADDRESS(STREET ADDRESS;CITY,STATE.ZIP): I EVENING PHONE: -) /
841 POWELL AVE SW // 101 - ) --;("
Renton, WA 98055 , ( J )7`,
RELATIONSHIP TO PROJECT: i FAX NUMBER:
❑ ARCHITECT ❑TENANT ❑ OTHER ( DESCRIBE): ( ) -
E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER Et APPLICANT ❑ CONTRACTOR I
.11 DETAILED=BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTILY** •
44..
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
s ■ 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:
- `=`■ `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)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 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 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 daim arises out of the reliance of the city,including its officers and employees, upon the accuracy
of the information supplied to the city as a part of this application.
NAME/TITLE: Tom Estep DATE: C 7— (6-1.
C
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
_FOR'OFFICE.USE
[7 NEW r� ($'ADDITION p ALTERATION D REPAIR. i].TENANT IMPROVEMENT
?CENSUS`CODE * ' R- 0. , ' -`• LOT SIZE + ��' -
yZONING DESIGNATION , ,g,.040 ""40 BUILDING SHELL ONLY? c YES�'F.a NO-.,~
COMP PLAN DESIGNATION (BASIC PLAN? ❑YES `�❑,NO 3
SECTION TOWNSHIP.`. RANGE ; „,:' .,. ", ,
f „NEW.ADDRESS REQUIRED? „,'�O.❑YES k4•.6 NO
`PLATTED LOT? `b❑YES p`NO , ,1.CHANGE OF USE?,-4 ,,:; :O YES t.13 NO -
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www,dityoffederl iwl Y.com
Constrillon Permit Fee Calculation Sh•
*******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$4.00 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 5'1,000.00 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 513.00 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$1.000.02 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$1,000.00 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 add2ional sLooa00 or fraction thereof.
Bold number Is the base fee for the spedned Increment
ltalldzed,gindert/ned number Is the fee ver additional spedt7ed 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,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**
R 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)
U FIRE PREVENTION SYSTEM =:.
PROPOSED VALUATION: r ?C..)(
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
iiscellaneous Fixture Charge: (10)
Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)