01-102313 •
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RUAION PERMIT APPLICATION
' A . 'TION NUMBER: .1111111L..... - ,, )
LPPLICATION NUMBER: - -
UN 1 1 L PPLICATION NUMBER: - -
VL i,L�L,.,ALpL vvWhe following is required information-Please print(in ink)or type**
aeOnoPePileTctrical, Fire Prevention Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: /3O < - '5c. 0t40
4( ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): _ .
- - • PROJECT INFORMATION _ • -
TYPE OF PROJECT(This application): ❑ BUILDING El PLUMBING El MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): L 3 14# a if L - if_4e . - mi
PROJECT NAME: PDOJ4 MPA WI ' 6747elttigT
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: -/��y.T/)�rj��'��! ki- L/iU��✓j '/�� ,+''ly L��C DAYTIME PHONE:
• M G ADDRESS(STREET ADDRESS,Cl STATE,ZIP) ( )
3t Mr ,5 C)6 S 517E-
CONTRACTOR: /NAME: DAYTIME PHONE:
6")ARD ilitil c e1.t:/Q1 8��em (0 )&7Z - 4Sri
MAILING A DRESS(STREET DR SS;CITY,STATE,ZIP: EVENING PHONE:
//13 —/Dri Ve ZS ( ) -
Cu OF FEDERAL WAY BUSINESS UC NSE NUMBER: FAX NUMBER:
- — m _ii,t _ _i _ (- 4( -9q1
CONTRACTOR'S REGISTRATION NUMBER: r EXPIRATION DATE:
6 SG LT
(copy of card required) L t) 5 5 6 �2 �/ /3) /V - j
APPLICANT: NAAME:: � DAYTIME PH
ONE:
_$47/n V ,t ( )
MAIUNGXDDR4 SSTREE � STATE,
ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: //�� �� /1ZnFAX NUMBER:
Cl ARCHITECT CI TENANT iii OTHER(DESCRIBE):(')?' 7 /2—. ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: CIPROPERTY OWNER ❑ APPLICANT CICONTRACTOR
• ■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ / V
PROPOSED USE: . PROPOSED VALUATION FOR IMPROVEMENTS: $ 4
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER:- ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
4111
**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:
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 ofthe 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:�(�)2,(44—) k.),t-J v../ DATE: '7 I
❑ PROPERTY OWNER ❑ APPLICANT iRCONTRACTOR
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 Cl NO CHANGE OF USE? ❑ YES ❑ NO
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I
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.
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 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$1,000 00 or fraction thereof,to and including
525,000 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 OO 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$750 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 including
$500,000.00
(7)$500,001.00 to 51,000,000 00 (7)$3,337.23 for the fist$500,000.00 plus$509 for each additional$1,000 00 or fraction thereof,to and including
51,000,000 00.
(8)$1,000,001 00 and up (8)$5,788.23 for the first$1,000,000.00 plus$391 for each additional$1,000 OO or fraction thereof.
Bold number is the base fee for the specified increment
Italicized,underlined number is the fee 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 Distnct#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: 12 DI
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 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)
Si ih Tnfi d in,...n,,..1' I mac) (15 a(7)+(Z)+f4l+(c)+(F,l+(754-(R)+(41+(1 nl = 1.1 11