01-103697 RECEIVED
CITY°I' G CONSTRUCTION PERMIT APPLICATION
- �E - .APPLICATION NUMBER: I - 103_433- au
SEP 1 9 ?f`!I1 APPLICATION NUMBER: - -
CITY OF FEDERAL WAY APPLICATION NUMBER: -
D" ' DING DEPT.
aPlea **The following is required information-Please print(In ink)or type** n ' /(-)7 04/5--06--
Please
se note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application. C'c
• PROPERTY INFORMATION
3121 -1 ' i '
SITE ADDRESS: e • 0, . 4ASSESSOR'S TAX/PARCEL#: Q Z 1 O Li- q 1 18
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING 0 MECHANICAL o DEMOLITION
❑ ELECTRICAL o ENGINEERING,-FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
<fre .)/o_f_,2 -r. T.
PROJECT NAME: PAPA ik Ul IeFS`T
-s
0 • PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
�/E�A n)4 P ( G�ER[ O P�2_A-r--r ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE:
-cox ZCZ f• �2E-\)Ee-IT=o N (?c-()(o Z3- 2-9C 3
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP: EVENING PHONE:
3 a x '=1 LI o(2--r- 0 2c-.14 alb 1f..1 la 9%3 ,10 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
AF L z- ra -o - - CMO)`a'7-/ - ZZ.C.c.
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
'. oxG = P11 7- -4- Mg / /
APPLICANT: NAME: DAYTIME PHONE:
4 P4yv\ C l_v..._ (zoo)(..C5 -299 3
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
Po �,\ si t i i'�,,,,ia-1- ogs_.14- 42o UJ A `t 3a, ( ) -
RELATIONSHIP TO PROJECT: ((`` FAX NUMBER:
❑ARCHITECT o TENANT OTHER(DESCRIBE): .)i&L L C01 Tfic ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER 0 APPLICANT ,l CONTRACTOR
• DETAILED BUILDING INFORMATION
EXISTING USE: RE11s..A '(3.-- EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ ` Z
J
PROPOSED USE: F---E.--5740 T RANPROPOSED VALUATION FOR IMPROVEMENTS: $ OI+J 0
SPRINKLERED BUILDING? /A YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:F,YES in NO
•
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**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:
■ 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: ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) c 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 claim(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 part this plication.
NAME/TITLE: � � DATE: 7 — / 5'
o PROPERTY OWNER APPLICANT ❑ CONTRACTOR
• y • •
PROPOSED VALUATION: Z-� O
FEE FACTOR FROM TABLE A: Number: (a)Base Fee: '2-
(b)Additional Increment Fee: LA•
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
• PLUMBING
Base Fee Number of Fixtures
$21.00+{ X$7.00/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)+(3)+(4)+(5)+ 6)+(7)+(8)+(9)+(10) = (11)
■ ELECTRICAL
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $44.25 _#of Thermostats(First-$33.50;add-n-S 10.50ea)
(First 1300 ft2-567.00;Each add-n 500 ft2-$21.50) _Service and feeder $72.25 _#of Low voltage fire or burglar alarms
Square Feet: First 2500 ft2-$38.75;Each addax 2500 ft2-$10.50
_Each outbuilding or garage S28.00 MOBILE HOME/RV PARK Square Feet:
(Inspected with service) #of service or feeders *Per WAC 296-46-910(5)(b)(i&ii)
_Each outbuilding or garage $44.25 (First service/feeder-S44.25:Add-n service/ _#of Signs(First sign-533.50;add=n sign
(Inspected separately) feeder-$28 each) $16.00 each)
_Progress inspection per 2 hr $33.50
_Swimming pool,hot tub,spa.................67.00
Yard Pole meter loops 44.25
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 $72.25
_Up to 200 amp $72.25 $21.50 Feeder _201-600 169.00
_201 -400 amp 89.75....................44.25 _0 to 100 S 72.25 $44.25 _601-1000 '54.50
_401 -600 amp 123.25 61.50 _101 -200 89.75 56.25 _over 1000 /82.75
_601 -800 amp 158.00 84.25 _201 -400 169.00 67.00 _(1 -n#of circuits
_Over 800 amp 225.25 169.00 _401 -600 197.00 78.75 -5 circuits-S56.25;Addcircuits,$5 ea)
ALTERED SINGLE/MULTI FAMILY _601-800 254.50 107.25
(When inspected separately from the services.) _801 -1000 310.75 129.75 Temporary Service
Service or Feeder _Over 1000 339.00.........181.00 _0 to 60 $38.75
_0 to 200 amp $61.50 _Over 600 volts surcharge 56.25 _61-100 44.25
_201-600 amp 89.75 _Mast or meter repair 61.50 _101 -200 56.25
_over 600 amp 135.25 _201 -400 67.00
_Mast or meter repair 33.50 _401 -600 89.75
_#of circuits _over 600 97.75
(1-4 circuits-544.25:Add-n circuits S5 ea)
If service is greater than 200 amp,a plan review is regd.Fee is 35%of permit fee+$56.25.Add=l plan review for other submissions is S67.00/hr.
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
TOTAL COLUMN(D):
Total Column(D)
Estimated Permit Fee: (12)
Estimated Permit Fee from One 12
Estimated Plan Review Fee: $56.25+ X.35 =(13)
111 DEMOLITION