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01-100330G_ CONSTRUCTION PERMIT APPLICATION W -'>ESL A� 2 PPLICATION NUMBER: d - 1 0 lb 4 APPLICATION NUMBER: - - -- ------ -- CITY OF FEDERAL WAY APPLICATION NUMBER: - - BUILDING DEPT, — — — — — — — — — — **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: �� S — S 04&l 320 "SZW CT 2�' r� _ _ _ 1� 5 ? ASSESSOR'S TAX/PARCEL #: / Z — LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): P—oz naal ®p La TS 57 56 DT- S 7.4 r E P1 A /Al S[ -C,, ib, -f Z ( , lz rf 0- 1197- V r- Kl A14� G2k,FVy J'ti�?—pi-.+r f/0 X91 z2Z �-C -l/0 Bgl�l�f 0;;5 -- AX -A• P4OPPSfie i< • e- e *P 09W2�T 5,J). O�A,;-- —' ■ PROJECT INFORMATION TYPE OF PROJECT (This application): J<BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION Rf ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description): !! /\AQ tZ 7-PiV~I- f( PROJECT NAME:(? Lh l t" �J�(�'fi.��' /IIrP�d�.4 A��-(� ©i GI/L• `f PEOPLE•• • PROPERTYOWNER: NAME: �hWFA-9 U1 DAYTIME HONE: MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): 250 CONTRACTOR: NAME: DAYTIME PHONE: ) MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE: CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: j CONTRACTOR'S REGISTRATION NUMBER:EXPIRATION (copy of card required) DATE: / APPLICANT: NAME: lq(ZA-& TAgA-A 1 G v Plc&cnr" lNvtf� MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): RELATIONSHIP TO PROJECT: ❑ ARCHITECT ❑ TENANT I OTHER( DESCRIBE):6VtCr CONTACT PERSON FOR THIS PROJECT: PROPERTY OWNER K APPLICANT ❑ CONTRACTOR EXISTING USE: /,(9&KF'e-(//' PAYTIME (zl��) PHONE:501 EVENING PHONE: ! ,( 76� )1/9 3'� Z ) E-MAIL ADD BUILDING ASSESSED/APPRAISED VALUATION PROPOSED USE: J PROPOSED VALUATION FOR IMPROVEMENTS: SPRINKLERED BUILDING?L,Y ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: E� YES El WATER SERVICE PROVIDER: IM LA EHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE WELL SEWER SERVICE PROVIDER: LAKEHAVEN 11 HIGHLINE ❑ PRIVATE (SEPTIC) ! 0 **NEW RESIDENTIAL CONSTRUCTION ONLY** r NUMBER OF BEDROOMS: / ESTIMATED SELLING PRICE: ■ PR03ECT FLOOR AREAS FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL BASEMENT BUILDING SHELL ONLY? ❑ YES NO COMP PLAN DESIGNATION G BASIC PLAN? ❑ YES NO FIRST NEW ADDRESS REQUIRED? ❑ YES ❑.NO PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO SECOND THIRD FOURTH OTHER FLOORS (DESCRIBE) DECK GARAGE HOW MANY FLOORS? TOTAL: AIR HANDLING UNIT(S) BBQ(S) BOILERS) COMPRESSOR(S) DUCT(S) BATHTUB(S) DISHWASHER(S)` DRINKING FOUNTAINS) GAS PIPE OUTLET(S) INTERCEPTORS) Indicate number of each type of fixture MECHANICAL EVAPORATIVE COOLER(S) GAS LOG(S) ` REFRIG. SYSTEM(S) FAN(S) HOODts)=-- - WOODSTOVE(S) FIREPLACE INSERT(S) -RANGES) MISC. ( ) FURNACE(S) - GAS PIPE OUTLETS} `'4 J HEAT SOURCE: ❑ ELECTRIC ❑ GAS PLUMBING LAVATORY(S) URINALS) WATER HEATER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS SHOWER(S) WASH MACHINE OUTLET SINKS) WATER CLOSET(S) MISC. ( ) SUMP(S) DTSCLATMFR/STGNATHRF- BLC 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 o such claim), which may be made by any person, including the undersigned, and filed against the City of Federal Way, but on l er s ch claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the informations pplied he city as a part of this application. NAME/TITLE: v L DATE: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR 9:nD n1:rTrF I ICF nNi v ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR TENANT IMPROVEMENT CENSUS CODE: LOT SIZE: ZONING DESIGNATION: f (� C' BUILDING SHELL ONLY? ❑ YES NO COMP PLAN DESIGNATION G BASIC PLAN? ❑ YES NO SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑.NO PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • P.O. BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129 • 0 Construction Permit Fee lation 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 $S00.00 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 ,$1500 for each additional $1000 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 $10.82 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, 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 addI62nal $1,000. or fraction thereof. Bold number is the base fee for the specified increment Italicized underlined number is the tee 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. PROPOSED VALUATION: ** Electrical, plumbing, and mechanical fees are calculated separately ** t� ,L 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) E MECHANICAL PROPOSED VALUATION: Qj l FEE FACTOR FROM TABLE A: Number: Estimated Permit Fee: (4 Estimated Plan Review Fee: (5) (a) Base Fee: (b) Additional Increment Fee: - ■ FIRE PREVENTION SYSTEM ROP • / FEE FACTOR FROM TABLE A: Number: Estimated Permit Fee: Estimated Plan Review Fee: Base Fee Number of Fixtures $21.00+( X $7.00/fixture) _ Estimated Permit Fee X .65 = Miscellaneous Fixture Charge: (10) (a) Base Fee: (b) Additional Increment Fee: Sub Total (Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11) (8) Estimated Permit Fee (9) Estimated Plan Review Fee