03-102879 •RECEVEfl CONSTRUC l ON PERMIT APPLICATION
CITY OF -VP'-""••••....../. APPLICATION NUMBER Q7 -�
Federal Way JUL 1 4 t APPLICATION NUMBER:
IAPPLICATION NUMBER: -
**The following is required information- Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering
y g g permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: Cl l 3S �f�e, 6�VAI/ 55C,• ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): ??(.57----/9-, / ;5/46ppihiS
c Jibe
PROJECT INFORMATION ' ;
TYPE OF PROJECT(This application): o BUILDING o PLUMBING o MECHANICAL ❑ DEMOLITION
o ELECTRICAL ❑ ENGINEERING r_FJRE PREVENTION SYSTEM
)
PROJECT DESCRIPTION (Provide detailed description): / /•1S / /-)//i4A/6CW F./ / /ARP-1
syr'7:5;4-) 1A) "/c-vi ,+2e=TJ / 1 ?LAI 1 , SKe=zL c>>tiL v
PROJECT NAME: /✓M V/
;:;I PEOPLE INFORMATION
PROPERTY OWNER: NAME: ; DAYTIME PHONE•
cH /A/1)&5:5'r-Ail Lei)T ` 2CiPt 2 Ti L`T 5 i (
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
/2 \51/Ni $, /)MOI ) Sr. 76,e7--11,)0 Op, 17090,E
CONTRACTOR: NAME: DAYTIME PHONE:
e-,��2K C�/6d ,e (425 )8. -3330
MAILING ADORES
(STREET ADDRESS;CITY,STATE.ZIP): i. EVENING PHONE:
i !U- eON s` 4 a,2TP _ 7 I • k(A • q&11-5— ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
jc• 002 - I 5-r - o G ; (4 ) 83377
CONTRACTOR'S REGISTRATION NUMBER: I EXPIRATION DATE:
T
(copy of card required) 3 L 1 E g 3 Re � i 'd8
6`3
I
APPLICANT: NAME: DAYTIME PHONE:
� ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
I �
RELATIONSHIP TO PROJECT: FAX NUMBER:
O ARCHITECT 0 TENANT ❑ OTHER ( DESCRIBE): I ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
■ DETAILED•BUILDING INFORMATION _ - -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
I�y'�
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ S (W
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC)
Constt ion Permit Fee Calculation S•ikt
*******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);30.00
(2)$501.00 to$2,000.00 (2);30.00 for the first;500.00 plus$4.00for each additional$100.00 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$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)$504.00 for the first$25,000.00 plus 513.00 for each additional$1,000.00 or 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 59.00 for each additional$1.000.0Q 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 17..Cb 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)$4,079.00 for the fist;500,000.00 plus$6.00 for each additional 51.000,00 or fraction thereof,to and
including$1,000,000.00
(8)$1,000,001.00 and up
(8);7,079.00 for the first$1,000,000.00 plus$1.50 for each additional$1,000.00 or fraction thereof.
Bold number is the base fee for the specified Increment
Italicized,underllned number is tile fee ver 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,commerdal only.
Add$4.50 for WA State Building Code Coundi,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:` -JCO
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
$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 one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)