02-103295J�
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Cr" °' �E-= OPCONSTRUCTION PERMIT APPLICATION
VV f�YAPPLICATION NUMBER: -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.
SITE ADDRESS: _3 �'t l q 5T-:5 &-,x TE 10.0 ASSESSOR'S TAX/PARCEL #: C 7 Z 1 0 q- 9 1 3 3
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING El FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): QE- Rcy.,�c^E maxis-r�C�J G mac- �fcckT JUTLE��I�
i13Lz- AAD C.A31..�. To IZ ►T�.� Lc�cxtr�ts�5
AIDA ACJ
PROJECT NAME: ST `1�ty�� TiJ gw (Z pS
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
NAME: DAYTIME PHONE:
_ 0 M N r 1pw rz z-N�tZ II ( ) -
MAILING ADDRESS (STREET ADDRESS, CITY, STATE, P).
god S 33(67H Z5rr S�.^rty io3 y r&De2AL +.,3A}) WA 99CO3 - S 2s6
NAME:
DAYTIME PHONE:
(N -G) 4211 - L(oo2
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
OL 0 99
5
CITY OF FEDERA WAY BUSINESS N�
BER:
FAX NUMBER:
- O L
-
CO REGISTRATION NUMBER:
EXPIRATIONDATE:
( of card requi
1C
L- E c I L-1
I
NAME:
DAYTIME PHONE:
( )
MAILING ADDRESS (STREET ADDRESS; CITY, $TATE, ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: FAX NUMBER
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE):
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT lig CONTRACTOR I
DETAILED 13UILDING INFORMATION'
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
❑ NO
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ 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:
.. �...d.y - .: :.%:.+ ��...y"=••-+.. �•sNv�a1i�+�Cu'wMA�aY�s�I:FiAf VRES ���xX!Jfit�`JN�.n�M+w.t�iw�O�DY'�AJ!t dlt.'i��t'��i14�l:i;A ...`�Y�kXai"w!kti+ti•..
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERTS) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S) URINAL(S) WATER HEATER(S)
RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
SHOWER(S) WASH MACHINE OUTLET
SINKS) WATER CLOSET(S) MISC. ( )
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�he Oty as a part of this application.
NAME/TITLE: DATE: -61MM
❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
aDMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.dtvofredem1wav_com
Ll
TABLE B
NEW RESIDENTIAL SERVICES
MOBILE HOMES
MISC EQUIPMENT/TEMP SERVICES
-Single Family
_ Service or feeder only ......................... $50.00
_ # of Thermostats (First -$37.50; add'n-S 11.50ca)
(First 1300 ft -$75.00; Each add'n 500 ft -$24.00)
_ Service and feeder ............................... $81.00
U # of Low voltage fire or burglar alarms
Square Feet:
outbuilding orgarage ...........................$31.00
MOBILE HOME/RV
First 2500 114 .50; Each add'n 2500 ft
add'n
Square Feet: Bs��
_Each
(Inspected with service)
PARK
_ # of service or feeders
• Per WAC 296A6-910(5)(b)(i & ii)
_ Each outbuilding or garage ........................... $50.00
(First service/feeder-$50.00; Add'n service/
_ # of Signs (First sign -$37.50; add'n sign
(Inspected separately)
feeder -$32 each)
$17.50 each)
Swimming pool, hot tub, spa ...............$75.00
_ Yard Pole meter loops .........................$50.00
NEW MULTI -FAMILY
COMMERCIAL/INDUSTRIAL
COMMERCIAL/INDUSTRIAL
(Includes three units or more)
Altered Service or Feeders
Service Feeder
Amps Service or Add'n
_ 0 to 200 ..............................................$ 81.00
_ Up to 200 amp .............. $ 81.00................ $ 24.00
Feeder
_ 201-600 .............................................. 189.00
201 - 400 amp ................ 101-00 .................... 50.00
_0 to 100.........................$ 81.00.------ $ 50.00
_ 601-1000 ............................................ 284.50
_ 401 - 600 amp ................ 138.00.................... 68.50
_ 101-200 ........................ 101.00........... 63.50
over 1000..---........................................317.00
_ 601 - 800 amp ................ 176.50 .................... 94.50
_ 201-400 ........................ 189.00........... 75.00
_
# of circuits
_ Over 800 amp ................. 252.50.................. 189.00
_ 401-600 ........................ 220.50........... 88.50
_
(1-5 circuits -$63.50; Add'n circuits, $5 ea)
ALTERED SINGLE/MULTI FAMILY
601-800 ........................ 284.50......... 120.50
(When inspected separately from the services.)
_ 801-1000 ...................... 348.00......... 145.50
TEMPORARY SERVICE
Service or Feeder
-Over 1000 ...................... 379.00......... 202.50
Residential/Multi-Family/Commercial/Industrial
_ 0 to 200 amp ............................................... $ 68.50
_ Over 600 volts surcharge ...................... 63.50
0-100 ................................................ S 50.00
_ 201 - 600 amp .............................................. 101.00
_ Mast or meter repair.............................. 68.50
_
101-200 ................................................ 63.50
over600 amp ................................................ 151.50
_
201-400 ................................................ 75.00
_ Mast or meter repair ....................................... 37.50
_
401-600 .............................................. 101.00
_ # of circuits
_
over 600 ............................................... 109.00
(IA circuits -$50.00; Add'n circuits $5 ea)
If a new or altered commercial se • ' 200
rvice is amps or greater, or a new or altered residential service is greater than 400 amps, a plan review is required. Fee is 35% of
permit fee +$63.50. Add'I plan review for other submissions is $75.00/hr.
Estimated Permit Fee: (1
Total Column (D)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $63.50 + ( X .35) = (13)
Estimated Permit Fee: (14)
Bond Amount: (15)
Estimated Permit Fee: (16)
Bond Amount: (17)
E
Mitigation Fee: (18) •
(20) (22)
SBCC Surcharge: (19) _ (21) (23)
total (Pagesone&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) =
Bulletin #100 -February 19, 2002