03-105476 4111
RECEIVED CONS I RUCTION PERMIT APPLICATION
ED LIGATION
CITY OF � APPLICATION NUMBER: Oa f CS Lt 7i-
Federal Way DEC 1 8 2000 APPLICATION NUMBER: - -
CITY OF FEDERAL WAY APPLICATION NUMBER: - -
"The folio VA CIrioformation—Please print(in ink) or type"
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY�IN�RMATJ<0 .,. � -..
SITE ADDRESS:4444' Q6c f c. poi tif L-bIdi• ASSESSOR'S TAX/PARCEL #:g O O 6
�BLEGAL DESCRIPTION OF SUJECIPRO PROPERTY
(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT(This application): o BUILDING ❑ PLUMBING o MECHANICAL o DEMOLITION
❑ ELECTRICAL 0 ENGINEERING FIRE PREVENTION�ISYSTEM �
PROJECT DESCRIPTION(Provide detailed description): f l f Bads far N
Ncw Y�6 t I (d "' Ri I(),I/iys
PROJECT NAME: LA "e43 r ' WLOSJ I I
�,•° .��t� - ' .:• PEOPLEINFORMATION'":��..' - w?.:T.. r4
PROPERTY OWNER: NAME:
DAYTIME PHONE
{�4r - -t\* PCD ler----'c S ; (
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
� � I
CONTRACTOR: ( NAME: DAYTIME PHONE:
• �a+P-U!+ F ll�, Q(-Otic+w1v ISG. Il (z5-3 ) 12-6 - 2.2
ILI
MAN ADDRESS(STREET ADDRESS;CRY,STATE.� ZIP):�/) /,j, I. EVENING PHONE:
l lb 1 AvlA./l e Fas I ( ) I
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
/ q - CIt of - _ � � (253) G7Z2 19150
CONTRACTOR'S REGISTRATION NUMBER: /� �J/ EXPIRATION DATE:
(ropy of Card required) P 6 -{'1 L L E F Q 1 I G F ; 10 / S oil
APPLICANT: NAME: DAYTIME PHONE'
MAILING 12( IP-0ADDRESS; '2S P)ogZb -22� ; .
•
•
RELATIONSHIP TO PROJECT: 1 r( I FAX NUMBER:
0 ARCHITECT ❑TENANT ,!�OTHER (DESCRIBE):.Sc 2 .CUyfT7�itTD/ (253 ) 'fib - 22-O
E-MAIL ADDRESS:
I
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER APPLICANT CONTRACTOR
-::E•11 DETAILED-BUILDING INFORMATION.:' ,
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
-PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? -YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION **
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■:PROTECT FLOOR AREAS`"
FLOOR EXISTING SQ. FT. PROPOSED Ss. FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH •
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
. . I-FIXTURES.:
Indicate number of each type of fixture
MECHANICAL Value of Mechanical Work: $
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: 0 ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC a 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,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the dty,induding its officers and employees,upon the accuracy
of the information supplied to the dty as a part of this application.
NAME/TITLE: _ .�4 I' DATE: la//d'/O
❑ PROPERTY OWNER APPLICANT o CONTRACTOR
_FOR,OFFICE:USE ONLY;•
NEW , u ADDITION ❑ALTERATIONii [3 REPAIR.__ :;❑.TENANT'IMPROVEMENT ;TIM-'
CENSUSCCODE -:
Con action Permit Fee Calculation Seet
*******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 prevVionis stem fees are based on the following schedule.
TABLE A
TOTAL VALUATION FEE FACTOR
(1)$1.00 to$500.00 (1)$30.00
(2)$501.00 to$2,000.00 (2)$30.00 for the first$500.00 plus$1.00 for each additional$1 ca Ao or fraction thereof,to and including
$2,000.00
(3)$2,001.00 to$25,000.00
(3)$90.00 for the first$2,000.00 plus 51600 for each additional$1,000.00or fraction thereof,to and
including$25,000.00
(4)$25,001.00 to$50,000.00
(4);504.00 for the first$25,000.00 plus$13.00 for each additional SI,000,OQor fraction thereof,to and
Including$50,000.00
(5)$50,001.00 to$100,000.00
(5)$829.00 for the first$50,000.00 plus$9.00 for each addition)$1,00000 or fraction thereof,to and
Including$100,000.00
(6)$100,001.00 to$500,000.00
(6)$1,279.00 for the first$100,000.00 plus S7.A7 for each additional$1000 o0 or fraction thereof,to and
inducting$500,000.00
(7)$500,001.00 to$1,000,000.00
(7)$4,079.00 for the fist$500,000.00 plus$6,00 for each additional S1,00000 or fraction thereof,to and
(8)$1,000,001.00 and up Including$1,000,000.00
(8)$7,079.00 for the first$1,000,000.00 plus$1.50 for each additional51.000.00or fraction thereof.
Bold number Is the base fee for the specified Increment
!Ya//c/red inderflned number Is the fee per#dslltlpna/snec1f ed 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,commerdal 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
..
_.._ ;:r � ,:�. ..- -�' 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)
N 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 s
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee: _
(b)Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
Base Fee
Number of Fixtures
$26.00+( X$9.00/fixture)= (8) Estimated Permit Fee
Estimated Permit Fee
X .65= (9) Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
Sub Total(Page ono: tine(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)