06-101093 MAR-3-2006 04: 10F' FROM:THORNE:ER 425155719059 0.538352609 P.2
ji,
RECEIVED CONSTRUCTION PERMIT APPLICATION
cu., OF �� APPLICATION NUMBER: _ - I .0J -
Federal Way MAR 0 8 2006 APPLICATION NUMBER: - -
APPLICATION NUMBER: - -
CI IY OF FEDERAL WAY
"The IssupkiNtla[ aped Information—Please print(in ink)or type"
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
.• . • : ' '. 1::'7.-'.... ■ 'PROPERTY INFORMATION . ' • _
SITE ADDRESS: �3 i 3 (St 1�StY ASSESSOR'S TAX/PARCEL tt: ` - 3 /
2a10� 1.. Q _
LEGAL DESCRIPTION OF SUDIJECT PROPERTY (ATTACH pARATE DESCRIPTION IF LENGTHY): Q.5101 '. -VI(p
kourliblamts
. .,.r.,-: `'' .. • . I. . - , . ■ PROJECT INFORMATION , • '
TYPE OF PROJECT (This application): O BUILDING )(PLUMBING 0 MECHANICAL O DEMOLITION
0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): ✓V L / ' .I 0,(A,04,,__,04, Os�j I1' �,.tky.-_1:01' . _ .
/ 4
A
I
PROJECT NAME: vJI. I Cast}-/•p(1
• U"��•'``PEOPLE INFORMATION ,:
PROPERTY OWNER: NAp -- __ nn ; D• ME PHO
I
�i alt ' V ' i1.�1 s. '.L, Yb Z' ' ( )
J MAILING ADpqD�RES1S(ST,RE(IT' ADDRESS; ,STATE,ZIP):(Q� /� A`' III
�L �p\ `/•�� /Q� L_ •' I 0
t ae)l 1 L-i-.-�• '••iC +4 V.} leA`Lu i W! ) i. 1 1 1! ✓ ---
CONTRACTOR: A�-'-7 d� - ' DA ME PHONE:
mid N Rtef RG e citf r uus II a-p) eo. , ire., . ' ( a 61 31A - 11'51
let ragS.CITY.STATE., EVENING PHONE
d la IL. 3 _ S' '...�1 • Dcq ( ) -
CITY•F FEDERAL WAY BUSINESS LICENSE NUMBER: _ i 4y �/�J //��,1 { FAx NUMBER:
CONTRACTORS REGISTRATION NUMBER: O O a LLv_ 5 "— oa " .L, ( `) 551 -(A059
N
(SPY a card requlrecl)
T a 0 Q KC.Q., a _ L4. ; °�PDa, /ATT:lq . / 'a5
APPLICANT: ( NAME. I DAYTIME PHONE
•
alb 0I 1-ert ek
{ ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE'
I RELATIONSHIP TO PROJECT: ( )
FAX NUMBER.
O ARCHITECT 0 TENANT 0 OTHER ( DESCRIBE): ( ) -
EMAIL ADDRESS
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT 0 CONTRACTOR B .
-' '1. - • •• . ' • ' . -U DETAILED BUILDING INFORMATION . • . . '
EXISTING USE: J k EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: 1[
PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑YES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES 0 NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
%',/. i7O.?Ylb0
425155719059 T 7'538
MAR-5-21=11-=16 04: 11P FROM:THORNBER a Jo_,52689
!'NEW RESIDENTIAL CONSTRUCTION .*
NUMBER OF BEDROOMS: l
•
ESTIMATED SELLING PRICE: $
1
111
.• • • PROJECT FLOOR AREAS
FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
IFOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE l
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: o ELECTRIC
GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) 0 ELECTRIC a GAS
DRINIQNG FOUNTAIN(S) SHOWER(S) 1 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 claim 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: ._16 to 6FA) 0I C, DATE: ' t)1p
❑ PROPERTY OWNER a APPLICANT o CONTRACTOR
.FOR OFFICE USE ONLY:
ifuEW r ��t�'�"AcioruoN ; k3i0
(ZONING DESIGNATION ;1 J y ALTEfi RA+r�TIO- N';'` BvV"I"LDIPNAGIRSHrEOoNiLTEN;ANpT IEuSiP
;R:O:pVENMO ET.i.ma 0' vCENSUS CODE� , 1 .IrS• tN' nu' i' Yai1N.* i-LOT SIZE . tr cifsp.:ZiiJt i•t %- a s.
.
^
COMPupLAN DESIGNATIONfm�fit"17r y z .,v_
4'r'"* � x:->�3 � ;<BASEC PLANT �`�'O YES jh❑ NO i�`1i °'��+s f ��; ,',G.r;.r.
liSEGTION 75,y4TOWNSN1IPs� y;,y RANGE«'ra ir;k NEIN ADDRESSYREQUIRED7 �,, 1p-YES i°ro'NO ;fi
PLATTEDL0T7 Y
.� o elst.r'❑ riol,•F F',rcF ?,S;p i•;CHANGE OF'USE?;ter•,s;x�`a'YES* a'NO ' �; il; t,i
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-1000•FAX:253-661-4129
MAR-3-.2006 04: 11P FROM:THORNBERG skt
425155719059 538352609 P.4
Coion Permit Fee Calculatio!s!et
•-__�..
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 VALUATIOtI FI L FACTOR
(1)$1.00 to MO CO (1)$30.00
(2)5501.00 to 52,000 00 (2)$30.00 for the first$500.00 plus$i. acme aillgiani
$2,000.00 _$_/t
11X1 mor fraction thcreo/,to and including
(3)$2,001.00 to$25.000.00
(3)$90.00 for the first$2,000.00 plus$JOCVJQLrdc&Mfihmd,g11, ppor fraction thereof,to and
(4)5Z5.o0I.00to$50,000.00 UKlvding$75.000.00
(4)$504.00 for the first$25,000.00 plus 111C0 for earh addiyazoaunzx or fraction thereof,to aril
(5)$50,001.00 to$t0o,000.00 Including$50,000.00
(5)$829.00 for the first$50,000.00 plus 1?,a[pLPdL/LdodwrduLoc217.L)or fraction thereof,to and
(6)S100,O0t Co to S,00,Opo.Oo lnduding$100,000.00
(6)$1,279.00 for the first$100,000.00 plus 171f.a vw-�"ddiffp/]d/.,f..L7 Lor fraction thereof,to and
(7)$500,001.00 to 51,090,000.00 including$500,000.00
`
(7)$4,079.00 for the fist$500,000.00 plus L6r ehrn actio,a/S1.c100.0Qor fraction thereof,to and
(8)$1,000,001.09 and up Including$1,000,000.00
(8)$7,079.00 for the first$1,000,000.00 plus fraction thereof.
Bold number Is the base fee for the specified Increment
!taldredl(Inderaned number[s11rc%r rslsAt analsDrd>ged/nmemen f
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 or the base building permit fee for Fire District$39 surcharge,commerdal 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*4
■ 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)
(cowl ONLY)
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:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
Base Fee Number fir Fixtures
$26.00 + ( X$9.00/fixture) = Q'O
Estimated Permit Fee (B) Estimated Permit Fee
X .65 =
(9) Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
Sub Total (pace one): Line(s)(1)+-(2)+(3)+(4).4_(5)+(6)+(7)+•(8)+(9)+,(to) _ (11)