03-100149 °5//Y
3 •
City of Federal Way
Community Development Services Building - Corcial Permit #:03 100149 - 00 - CO
33530 1st Way S
Federal Way,WA 98003-6210 p
Ph:253.661.4000 Fax:253 661.4129 Inspection request line: 253.835.3050
Project Name: ITTO UDON
Project Address: 34417 PACIFIC HWY S Parcel Number: 202104 9109
Project Description: Repair of damaged sheetrock and replacement of countertop
Owner Applicant Contractor Lender
DENNIS GROTHAUS NONE TAEK KIM NONE
4650 W OAKEY BLVD UNIT 2120
LAS VEGAS NV 89102 1863 58TH ST NE
NONE TACOMA WA 98422 NONE
Includes:
Census category: 437-Comm #1 #2 #3 #4
Occupancy Group: — —
Construction Type:
Occupancy Load: J
Floor Area(Sq.Ft.): r
Census Category 437-Commercial alt/add Mechanical No
Number of Stories 1 Permit for Building Shell Only No
Plumbing No
PERMIT EXPIRES July 12,2003,IF NO WORK IS STARTED.
Permit issued on January 13,2003
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws,rules and regulations of the State of Washington and
the City of Federal
Owner or agent: /,111. / / Date: ( , 3 e
a„o. G CONSTRON PERMIT APPLICATION
EIDEfZI:=11__
\>\> FEY APPLICATION NUMBER: D - oO A /- 012
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. i`U
■ PROPERTY INFORMATION
SITE ADDRESS: '4 / ASSESSOR'S TAX/PARCEL#: ZbZL D Lt -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): 2 C, 2 /O 41. 0 ' O
• C C W — .
[ a - !
...:_.
-• 'PROTECT INFORMATION`
TYPE OF PROJECT(This application): Or BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): dP
A C'� ' 'A/21/�ALW- MA( Sk &ZOCL
E- eDGUfi .
PROJECT NAME: T TTv OD A/
• ■ PEOPLE INFORMATION •
PROPERTY OWNER: NAME: DAYTIME PHONE:
L7 RVTKd4 US / Ge NN/S ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,IIP):
6.S0 w o,k SLvp 41-2-1ZO L, Sv e.,,4S PJv 71 (a7
CONTRACTOR: NAME: DAYTIME PHONE:
6w&GIL- pc-et.-wt l ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
( )
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required)
APPLICANT: NAME: DAYTIME PHONE
7/-I0k k1AA (2-5-3) 1 q - '3/a.
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
/773 c8-/ti S-F . Nr. TAC AIA WA R$ .z z (2o6) 41,- 6 2_7
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT TENANT ❑ OTHER(DESCRIBE): ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ,,1 APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION • / •
EXISTING USE: pg-57A4IRi4/V 7 EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ 36 Z , ' 0
PROPOSED USE: let5T1,/24AJ7 PROPOSED VALUATION FOR IMPROVEMENTS: $ 2 0 00
SPRINKLERED BUILDING? ❑/YES l7 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:EVES CI NO
WATER SERVICE PROVIDER: L�?J, LAKEHAVEN ❑ HIGHLINE CI TACOMA CI PRIVATE(WELL)
SEWER SERVICE PROVIDER: L�LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
•**NEW RESIDENTIALCONSTRUCTIOADLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• ■ PROSECT FLOOR AREAS •
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
FZA/Vyam.
RE.7acri:.+e':r!✓i�ye�"•i....:wrw.w....:. e»a iwi .":ae*'ss�%4-u+ra.--iau.�+ -a�Y._:+..wkra.aa..
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 ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ 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 daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such claim 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 p of is application.
NAM E/TITLE:
DATE: /2 2. ."7/b Z❑ PROPERTY OWNER APPLICANT ElCONTRACTOR
FOR OFFICE USEONLY:
tI NEW: ..,.. , ElADDITION,:',_ .❑;ALTERATION TENANT IMPROVEMENT
ZONING ESIGNAfrON '� S .a:p� �
-=:x�. _..: __ -� g ��,r -�. t--�_ 'BCIIL:DING SHELL ONLY?,�❑YES t.O NO �.��
SECTIUN� _- TOW�.:NSHIP RANGE'
`
OMPLADESGNAON ` ��'
� NEW lb-61'6s REQUIRED? ' 1:1
�❑ N,O ;;
pPL TTED LOT?` CI Yes
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtvoffederalway.com
C.truction Permit Fee Calculaticheet
*******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)$26.00
(2)$501.00 to$2,000.00 (2)$26.00 for the first$500.00 plus . .r •,• ...'io .l M.U i or fraction thereof,to and including
$2,000.00
(3)$2,001.00 to$25,000.00
(3)$78.50 for the first$2,000.00 plus$15.50 for each additional$L000.00or fraction thereof,to and
including$25,000.00
(4)$25,001.00 to$50,000.00
(4)$435.00 for the first$25,000.00 plus$11.00 for each additional$1,000.00 or fraction thereof,to and
including$50,000.00.
(5)$50,001.00 to$100,000.00
(5)$710.00 for the first$50,000.00 plus$8.00 for each additional$1,000.00 or fraction thereof,to and
including$100,000.00.
(6)$100,001.00 to$500,000.00
(6)$1,110.00 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)$3,510.00 for the fist$500,000.00 plus$5.50 for each additional$1,000.00 or fraction thereof,to and
including$1,000,000.00.
(8)$1,000,001.00 and up
(8)$6,260.00 for the first$1,000,000.00 plus$4.00 for each additional$1.000.00 or fraction thereof.
Bold number is the base fee for the specified Increment
Italicized,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**
PROPOSED VALUATION: ir 7 / 0 d 0
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:
)914
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:
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
$22.50+{ X$8.00/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)4-(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10)= (11)