03-100727 REC CONSTRUC I ION PERMIT APPLICATION
CITY OF �.....
RECEIVED
0 �. �.- ` `- iI
APPLICATION NUMBER: '�- U( Z -
Federal Way FFR 1 9 2003 APPLICATION NUMBER: - -
IAPPLICATION NUMBER: - -
"The following
CITY
ti rTkf�in-Please print(in ink) or type"
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: 36cI` /Yo —� S ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
•
• PROJECT INFORMATION
TYPE OF PROJECT(This application): n BUILDING Li PLUMBING ❑ MECHANICAL n DEMOLITION
1LECTRICAL n ENGINEERING Cl FIRE PREVENTION SYSTEM
PROJ.ECT DESCRIPTION (Provide detailed description):
/Pi 1 --1 r
JECT NAME: )LN CXJ� ,Q/I( h Le't-/I L(J ) I
flodd
• PEOPLEINFORMATION
PROPERTY OWNER: ' NAME: { DAYTIME PHONE
..VL._ A. � I ` L ( ) -
M• LING ADD•ESS(STREET '-I RESS;CITY, •TE,ZIP):
CONTRACTOR: ( NAME: -__,, DAYTIME PHONE. (/ JO
MQI.Ilt ADDRESS(ST E`T/ADDRE •CITY,STATE.ZIP): j�G
`''ff// L Z A EL-44/t L 7 b 04-49f ./71 ( ) Q [',(L
I CITY OF FEDERAL WAY BUS NESS CENSE NUMBER: { FAX NUMBER: 9) 2 w/y f'f
(2.13) �
CONTRACTOR'S REGISTRATION NUMBER: � ���� 994/J
� j�,- EXPIRATION DATE:
(copy of card required) 4 l /
A ICANT: I NAM
-��� DAYTIME PHONE: /
MAILING ADDRESS( DDRES. TE,IP e.17 -- ,T,t.. v3) 9 4,/-,o Ai
EVENING PHONE:
Z /I�
4) 7 ( / &)9,r T1 id (.4)41-- ; ( )
{ RELATIONSHIP TO PROJECT: FAX NUMBER:
0 ARCHITECT ❑ TENANT C�..OTHER( DESCRIBE): P/20,770.71441 9S3 ) ?)9 'O/f, 1
j E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER )PPLICANT ❑ CONTRACTOR I
'■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? LI YES n NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES v NO
WATER SERVICE PROVIDER: u LAKEHAVEN u HIGHLINE O TACOMA n PRIVATE (WELL)
SEWER SERVICE PROVIDER: u LAKEHAVEN r I HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
- ■ PRO3ECT 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) o ELECTRIC o 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 daim arises •ut of the reli•• ce of the :ty,induding its officers and employees,upon the accuracy
of the informatio •plie• to the ci as`a p.,,r••fthis app' ••tion.
NAME/TITLE: A V i _ , ��i/y7fI1�L1�,� DATE: 42//9A___5
TININ
❑ PROPERTY OWNER o APPLICANT CONTRACTOR
_FOR OFFICE USE ONLY:
I7 NEW „0 ADDITION ❑ALTERATION - o REPAIR - -7.TENANT-IMPROVEMENT'n "
•+CENSUS°CODE:', _ LOT SIZE, , r a ° ;
-2ONING;DESIGNATION: = :? "" BUILDING SHELL ONLY? °❑YES --❑ NO
COMP PLAN DESIGNATION BASICPLAN?"-, c YES ❑'NO,:
;SECTION -,z-,:.7..--,;;`.TOWNSHIP RANGE NEW ADDRESS"REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ,.s❑YES ❑ NO CHANGEOF USE7, =, ".' H YES"`-n NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dh'9federal way.com
■ ELECTRICAL
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
Single Family _Service or feeder only $57.00 #of Thermostats(First-$43.00;add'n-$13.00ea)
_
(First 1300 ft2-$85.50;Each add'n 500 11
2
-527.50) _Service and(ceder $93.00 _#of Low voltage fire or burglar alarms
Square Feet: First 2500 f11-$50.00;Each add'n 2500 ft`-$13.00
Each outbuilding or garage $35.50 MOBILE HOME/RV PARK Square Feet: Q be/Li
(Inspected with service) _ii of service or feeders •Per WAC 96-46-910(5)(b)(i&ii)
_Each outbuilding or garage $57.00 (First service/feeder-S57.00;Add'n service/ _#of Signs(First sign-$43.00;add'n sign
(Inspected separately) feeder-$37 each) - $20.00 each)
Swimming pool,hot tub,spa $85.50
Yard Pole meter loops $57.00
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 5 93.00
_Up to 200 amp S 93.00 $ 27.50 Feeder _201 -600 216.50 t
201 -400 amp 115.50 57.00 _0 to 100 193.00 S 57.00 _601 -1000 326.50
_401 -600 amp 158.50 78.50 _101 -200 115.50 72.50 _over 1000 363.00
_601 -800 amp 202.50 108.50 _201-400 216.50 85.50 #of circuits
_Over 800 amp 289.50 216.50 _401-600 252.50 101.00 (I-5 circuits-$72.50;Add'n circuits,$6 ea)
ALTERED SINGLE/MULTI FAMILY _601 -800 326.50 138.00
(When inspected separately from the services.) _801 -1000 399.00 166.50 TEMPORARY SERVICE '
Service or Feeder _Over 1000 434.50 232.00 Residential/Multi-Family/Commerciai/Industrial
_0 to 200 amp $ 71.50 _Over 600 volts surcharge 72.50 _0-100 $ 57.00
_201-600 amp 115.50 _Mast or meter repair 78.50 _101 -200 72.50
over 600 amp 174.00 _201 -400 85.50
_Mast or meter repair 43.00 _401 -600 115.50
_#of circuits _over 600 125.00
(1-4 circuits-$57.00;Add'n circuits$6 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 review is required.Fee is 35%of
permit fee+$72.50.Add'I plan review for other submissions is$85.50/hr. a
I
FIXTURE DESCRIPTION (A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
_ � I
TOTAL COLUMN(D): I
Total Column(0) '
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $72.50 + ( X.35) = (13)
. . _ .- . . . ■ 'DEMOLITION
Estimated Permit Fee: (14)
Bond Amount: (15)
ENGINEERING •
Estimated Permit Fee: (16)
Bond Amount: (17)
i 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-December 23, 2002