01-103915 WCEIVEB �8��
u*ror .G
_ CONSTRU�ON PERMIT APPLICATION
OCT (1 R 2001 APPLICATION NUMBER: Q / - 1 .03J /4- Fla)
CITY OF I EDERAL WAY APPLICATION NUMBER: - -
BUILDING DEPT. 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.
• PROPERTY INFORMATION
SITE ADDRESS: '/i o2O /'5l 74 JI ie.. s , ASSESSOR'S TAX/PARCEL#: Q k z 1 O -- 2 v
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROTECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): //VS 74-4-A A'/JZ}3 ,4-1,416N) .5'syss7;&"")11
PROJECT NAME: 4/ .z.gre 7-8 PA 'S # `7` 9a.
- - " ■ PEOPLE INFORMATION
PROPERTY OWNER: NAME' DAYTIME PHONE:
/9 ,846 7 t,'V '.s 1/i3( ( ) -
MAILING ADDRESS(STREET ADDRESS;QTY,STATE,ZIP): ii
/
31 0.2.0 / r#4- S. Fe-N6 '14-G 4/ Wii 93')o3
CONTRACTOR: NAME: DAYTIME PHONE:
Cc(il 2 S&C.:cki rz�- C94/s:rern s /4/c , ( 33 ) (fWs- -86&s
MAILING/JLINGAADDRESS(STREET ADDRESS;"►n STATE, P): y/ EVENING PHONE:
CTTY OF oZ BUSINESS S TNUMBER:S'E • 744 �/ AM ( )
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: /� ��?` 2 t EXPIRATION DATE:
(copy of cardi..required) 5 S S C o� D / /
APPLICANT: NAME: „.. DAYTIME PHONE:
I o e/(47-4/.J 4�'-l2>� (6253)�' 'S - 8l�10C
MAILING ADDRESS(STRF1ET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
118' c”. 8 JJ s 7; S. E - i.c/a,Ayte AM 9837)- ( ) -
I RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION 0 Y** •
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) ❑ 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 daim(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 ci s p rt of this application.
NAME/TITLE: DATE: 69/6 0/
❑ PROPERTY 0 NER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW< ;:•-- ❑ADDITION ❑ ALTERATION ❑ REPAIR . ❑ TENANT IMPROVEMENT
CENSUS CODE: - -LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? ;.❑ YES ❑ NO
COMkPLAN 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
Construction Permit _._.,Luiation 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$500.00 plus$3.27 far 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$15.00 for each additional$1.000.00 or fraction thereof,to and induding
$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 induding
$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$1,000.00 or fraction thereof,to and induding
$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 additional$1.000.00 or fraction thereof.
Bold number is the base fee for the specified increment
jtalid%zed unden7ned number Is the fee tier 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.
**Electrical,plumbing,and mechanical fees are calculated separately**
• 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)
(COMMERCIAL ONLY)
■ MECHANICAL
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)
• PLUMBING
Base Fee Number of Fodures
$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)
-)aABLE B
R ).
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $48.00 _#of Thermostats(First-$36.00;add'n-$I 1.00ea)
(First 1300 ft2-$72.00;Each add'n 500 ft2-$23.00) _Service and feeder $78.00 _#of Low voltage fire or burglar alarms
Square Feet: First 2500 ft2-$42.00;Each add'n 2500 ft2-$11.00
IEach outbuilding or garage $30.00 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 $48.00 (First service/feeder-$48.00;Add'n service/ _#of Signs(First sign-$36.00;add'n sign
(Inspected separately) feeder-$31 each) $17.00 each)
_Swimming pool,hot tub,spa 72.00
_Yard Pole meter loops 48.00
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 $ 78.00
_Up to 200 amp $ 78.00 S 23.00 Feeder _201-600 182.00
_201-400 amp 97.00 48.00 _0 to 100 $ 78.00 $ 48.00 _601-1000 274.00
401-600 amp 133.00 66.00 _
_ 101-200 97.00 61.00 _over 1000 305.00
601-800 amp 170.00 91.00 _201-400' 182.00 72.00 _#of circuits
_Over 800 amp 243.00 182.00 _401-600 212.00 85.00 (l-5 circuits-$61.00;Add'n circuits,$5 ea)
ALTERED SINGLE/MULTI FAMILY _601-800 274.00 116.00
(When inspected separately from the services.) _801-1000 335.00 140.00 TEMPORARY SERVICE
Service or Feeder _Over 1000 365.00 195.00 Residential/Multi-Family/Commercial/Industiral
_0 to 200 amp $66.00 _Over 600 volts surcharge 61.00 _0-100 48.00
_201-600 amp 97.00 _Mast or meter repair 66.00 _101-200 61.00
_over 600 amp 146.00 _201-400 72.00
_Mast or meter repair 36.00 _401-600 97.00
#of circuits _over 600 105.00
(1-4 circuits-$48.00;Add'n circuits$5 ea)
If service is greater than 200 amp,a plan review is req'd.Fee is 35%of permit fee+$61.00.Add'l plan review for other submissions is$72.00/hr.
liliPIXTURETIESCRIKION'(A) 1FIXTUREtEE°<FROM TABLES Or'- NUMBER'ORUNITS{C)110104 W100401l0l*TOTAL#(D)Vi i 'i
„.. : ,., :..OTAL'COLUMN(D):
Total Column(0)
Estimated Permit Fee: (12)
Estimated Permit Fee from One 12
Estimated Plan Review Fee: $56.25+ X.35=(13)
■ DEMOLITION
Estimated Permit Fee: (14)
Bond Amount:(15)
• ENGINEERING
Estimated Permit Fee:(16)
Bond Amount: (17)
• OTHER FEES
Mitigation Fee: (18) (20) (22)
SBCC Surcharge: (19) (21) (23)
Total(Pages one&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23)_ (24)
Bulletin#100-August 20,2001