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03-100098 RECEIVED CITY G CONSTRUCTION PERMIT APPLICATION EciFM' JAN 0 8 2003 APPLICATION NUMBER: 0 3 - /� ©� .�- !J_ APPLICATION NUMBER: -CITY OF FEDERAL WAY APPLICATION NUMBER: - - BUILDING DEPT. **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: 36//t /6 ' /Wp< S• ASSESSOR'S TAX/PARCEL#: a9?(o Li- q v LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): -/vet Feckka.1 Way SilG,00/ (Todd i1ee) • PROJECT INFORMATION TYPE OF PROJECT(This application): ❑ BUILDING o PLUMBING ❑ MECHANICAL o DEMOLITION ❑ ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): N CU, 1AL` tA. SC_A.00( i WDLL/ �.D UL7 V O 1�0.g C-0✓44Mn 014; e[e_T-i`o vl Ca Go t i ung. // ll PROJECT NAME: N R..A) Kl`%1A S cIAbO ` Tad • PEOPLE INFORMATION PROPERTY OWNER: NAME: DAYTIME PHONE: Fede, .l W SCtti ( (Ifs �cr (0253) 9Li5"- .2ft00MAILING _ ,ZIP): 3/4'2ADDRESS S7D�C.-, S.;REsS;CITY, Er et&I&', W4 ?"8 003 CONTRACTOR: NAME: DAYTIME PHONE E`Z J 'Te-iFact (253 ) __X555 MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE //// S. 3yy '1/ sr 57F. 020.2 F etcti 1142 , at 9 (-253) *if -6-C6.5. CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: - (e253) yyy - 5555" CONTRACTOR'S REGISTRATION NUMBER: �i � EXPIRATION DATE: (copy of card required) E Z I ' iT o- L D / / (7 1 /02003 APPLICANT: NAME: DAYTIME PHONE: E-.Zr�✓i�iPFa.�e (.253) - 5753-S7 MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE: //// S. 394/71/ sr sTE. 2002 FedaPal lt&j, �t/a i8 7O3 (253) /yy RELATIONSHIP TO PROJECT: FAX NUMBER ❑ ARCHITECT o TENANT OTHER(DESCRIBE): (253) yyy - 5555— E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER (APPLICANT ❑ CONTRACTOR , 7 (2t42 EAZ'f.cAI'17 • DETAILED BUILDING INFORMATION EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: YES NO WATER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE ❑ TACOMA PRIVATE (WELL) SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) i **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 I 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) a 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 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 sup ied o the city as a part of this application. (� NAME/TITLE: DATE: ///O 3 ❑ PROPERTY OWNER ((APPLICANT o CONTRACTOR FOR OFFICE USE ONLY: ❑ NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT CENSUS CODE: LOT SIZE: ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES n NO COMP PLAN DESIGNATION BASIC PLAN? o YES o NO SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO PLATTED LOT? o YES ❑ NO CHANGE OF USE? o YES o NO COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX, 253 bo www.citvoffederalway.com • • ELECTRICAL TABLE B NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES Single Family _Service or feeder only $50.00 #of I hermostats(I•first-537 50.add'n-S1 i �i ica i (First 1300 ft2-$75.00;Each add'n 500 ft2-$24.00) _Service and feeder $81.00 g of Low-voltage fuc or burglar alai-r„o Square Feet: I.nrst 2500 11'-54 3 50.I.aeh ddrn 2_5,A, n -5! Each outbuilding or garage $31.00 MOBILE HOME/RV PARK Square Feer 16/_.1/ . (Inspected with service) _#of service or feeders * Per WA(. '')o-4(, i)1 r u;u h ,,\, -Each outbuilding or garage $50.00 (First service/feeder-$50.00;Add'n service/ __„5 01 Signs(First irst stgrt-s3 .-,0.add/ n .igi. (Inspected separately) feeder-$32 each) 517 50 each) __ Swimming pool.but!uh.:na Yard Pole mete/ limp. 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 300 5] 110 _Up to 200 amp $ 81.00 $ 24.00 Feeder 201 -600 -201 -400 amp 101.00 50.00 0 to 100 S 81.00 S 50(8 601 - H00 tt t - _401 -600 amp 138.00 68.50 _101 -200 101.00 63.>0 uv i..1- i 0Ut i 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 (1-5eucuits-5t,t 5n- Add=n ., c,.�.1. _ ALTERED SINGLE/MULTI FAMILY _601 -800 284 50 . 120 50 (When inspected separately from the services.) _801 - 1000 148.00 145 50 TEMPORARY SERVICE Service or Feeder _Over 1000 179.00 _. ..2(12.50 Residential vin an.n..-I a _0 to 200 amp $ 68.50 _Over 600 volts surcharge 63.50 0- 100 5 Sit u t( 201 -600 amp 101.00 _Mast or meter repair 68.50 -101 -200 03.50 _over 600 amp 151.50 _201 -400 75.00 -Mast or meter repair 37.50 _401 -600 1(1100 _#of circuits over 600. . . 1,rn i s (1-4 circuits-$50.00;Add'n circuits$5 ea) If a new or altered commercial service is 200 amps or greater,or a new or altered residential service is greater than 400 amps.a plan rev Irv% I.Ivonncd Iv, permit fee+$63.50.Add=1 plan review for other submissions is$75.00/hr. FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) . TOTAL(D) 1 TOTAL COLUMN(D): 1 Total Column(D) Estimated Permit Fee: (12) Estimated Permit Fee from line 12 Estimated Plan Review Fee: $63.50+( 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) TotaI (Pages One&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) = (24) Bulletin #100-February 19, 2002