02-102970a
RECEIVED
�TOF CONSTRUCTION PERMIT APPLICATION
-I �'� la APPLICATION NUMBER: - ' � -
_
JUL 1 5 2002 - �
PPLICATION NUMBER: - -
CITY OF FEDERAL WAY APPLICATION NUMBER:
RRUILDING DEPT
**The foll5wing is required information —Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
Q 2 PROPERTY• •
SITE ADDRESS: / �o• J c�8 �K/gzG! ASSESSOR'S TAX/ PARCEL #:
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): _
■ PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING NVIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): / e -W— A1�16 �/�%/Y/r(L�f�/� r f ,
PROJECT NAME:
PEOPLE INFORMATION
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
NAME. DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
'0 &x 3480 CZ6-X�4&29 TaNN 3 7324 3 80
NAME:
RK-41oT�71- WV
J -XJ` Geis 44-C
DAYTIME PHONE:
(253) 8 z -
oS
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
Zoo z / ^ 849 & So
&�ia W , 11q96)37_
EVENING PHONE:
(z.66) q30 -
6686
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
-
FAX NUMBER:
(zs,� 87z -
9os"9
CONTRACTOR'S REGISTRATION NUMBER:
� L/5610
SZ98IK
EXPIRATION DATE:
lz
/off
(Copy of card required) _
_ _ _ — — —
NAME: DAYTIME PHONE:
oZ C%- oiY j f S GCC �S" ) 87 - -9WY
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
Zoo - 80 )( �. 9'803 Z Gao y3o - doSo
RELATIONSHIP TO PROJECT: Q p FAXX
NUMBER: p !�
❑ ARCHITECT ❑ TENANT *OTHER ( DESCRIBE): S IJ ��Tf!!\ (Z5 --T) 920- /QJ y
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR I�/ S/ %/��,!//V/I`/tW9�C�i'• GU/i'i
BUILDINGDETAILED • •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
,,<YES ❑ NO
_kLAKEHAVEN
❑ LAKEHAVEN
PROPOSED VALUATION FOR IMPROVEMENTS: $ �q r o `''
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED:, (YES a NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
Construction Permit Fee Calculation 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.
PLUS:
11FAINNOT
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 $3.50 for each addition/3100
00 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 31550 far each ad&1ons/31
000 OO or 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 311 00 for each additions/
51 000 0 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 3B 00 (preach 3dd1tions1$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 3600 for each additional $1 000 OO 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 55 50 for each additions1$1
000 OO 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 S4 00 for each
additional $1 000 00 or fraction thereof.
Bold number is the base fee for the specified increment
!hired, underiinednumber isthe fec a radditionaiso
Tri din r men
yUCUIL u. uic ua�E uuuuuiy peinur iee iur pian 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:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee:
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number
Estimated Permit Fee: (4
Estimated Plan Review Fee: (5
(a) Base Fee:
(b) Additional Increment Fee:
(a) Base Fee:
(b) Additional Increment Fee:
PREVENTIONN FIRE
PROPOSED VALUATION: 0
FEE FACTOR FROM TABLE A: Number:_ (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (6)
6',�17 00
�f0 os
Estimated Plan Review Fee: 7 O
Base Fee Number of Fixtures
$22.50 + { X $8.00/fixture) _ (8) Estimated Permit Fee
Estimated Permit Fee
.65 =
Miscellaneous Fixture Charge: (10)
Sub Total (Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)
(9) Estimated Plan Review Fee
L_J
E
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FAN(S)
HOOD(S)
WOODSTOVE(S)
FIRST
FIREPLACEINSERT(S)
28 GI/
7� z7</
SECOND
FURNACE(S)
�J 7 21
17
THIRD
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
FOURTH
PLUMBING
OTHER FLOORS (DESCRIBE)
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
DECK
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
GARAGE
HOW MANY FLOORS?
SHOWER(S)
WASH MACHINE OUTLET
TOTAL:
SINK(S)
)
218 8
'] / li o
/ b 1O
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)
BOILERS)
FIREPLACEINSERT(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)
BLOCKDISCLAIM ER/SIGNATURE
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: DATE: / /5-- C�
❑ PROPERTY OWNE "" APPlICANT `S ONTI A OR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
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 • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.citvoffederalway.com