01-101185 GTS, G TO CONSTRUCTION PERMIT APPLICATION� - Z�ote wp1 APPLICATION NUMBER: I - f O/ f es-- OQ
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**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: 4700 SW Dash Point Road ASSESSOR'S TAX/PARCEL #: 1 1 2 1 0 3 - 9 0 1 0
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): West 723.36 Feet of
Government Lot 3, Section II, Township 21 North, Range 3 East, W.M.
• PROJECT INFORMATION
TYPE OF PROJECT(This application): milMOILIMPIG malINSIMIIIIIIG .7P MECHANICAL D41111111.1iiNTION {> L&4p ✓tel
❑ G M i
PROJECT DESCRIPTION (Provide detailed description): }'hPi foe_ rOPosoD proloc-rloN : Pw,074 I/L(
YhGh/P)Ltmb - Th e,chci,h'tcok q I umbir5o nl j i pt'PJcis1-jncc 831c1 , '
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V
Palisades Retreat Center-Addition
PROJECT NAME:
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
Archdiocese of Seattle -Pat Sursely (206) 382 4520
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
910 Marion Street, Seattle, Washington 98104
CONTRACTOR: NAME: DAYTIME PHONE:
Mountain Construction ( 253 ) 474- 5281
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
7457 South Madison St., Tacoma, Washington 98409 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
00-101959-00-BL - - ( 253) 474- 7699
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
I M O UN T C 1 1 7 9 N 2 12 / 31 / 01
APPLICANT: NAME: DAYTIME PHONE:
Kevin Broderick ( 206) 682 - 7525
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
55 South Atlantic St., Suite 301, Seattle, WA 98103 ( 206) 930- 8240
RELATIONSHIP TO PROJECT: FAX NUMBER:
gf ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): (206) 682- 7529
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER p APPLICANT ❑ CONTRACTOR kevin@broderickarchitects.com
• DETAILED BUILDING INFORMATION
EXISTING USE: Retreat Center EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ 2,200,000.00
PROPOSED USE: Retreat Center PROPOSED VALUATION FOR IMPROVEMENTS: $ 1,200,000.00
SPRINKLERED BUILDING? o YES NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:x YES o NO
/ 90 941023
i
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: X LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT 2,033 6,155 8,188
FIRST
14,120 5,407 19,527
SECOND
7,569 5,053 12,622
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS? 1
TOTAL: 23,722 16,615 40,337
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) 1 GAS LOG(S) REFRIG.SYSTEM(S
BBQ(S) 26 FAN(S) 1 HOOD(S) WOODSTOVE(S)
BOILER(S) 1 FIREPLACE INSERT(S) 1 RANGE(S) MISC. (
COMPRESSOR(S) 2 FURNACE(S)
DUCT(S) 2 GAS PIPE OUTLET(5) HEAT SOURCE: ELECTRIC X GAS
PLUMBING
BATHTUB(S) 30 LAVATORY(S) I URINAL(S) 2 WATER HEATER(S;
1 DISHWASHER(S) 1 RAIN WATER SYS. VACUUM BREAKER(5) ❑ ELECTRIC X GAS
1 DRINKING FOUNTAIN(S) 24 SHOWER(S) 2 WASH MACHINE OUTLET
GAS PIPE OUTLET(S) 4 SINK(S) 29 WATER CLOSET(S) MISC. (
1 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,an
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 th
investigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the City o
Federal Way, but only where such claim arises out of the reliance of the city, including its officers and employees,upon the accurac
of the information supplied to the city:s a part of this application.
NAME/TITLE: ►A JA / ,�� DATE: 3/23/0 1
❑ PROPERTY OWNER sAPPLICA T ❑ CONTRACTOR
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 04 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PRO)ECT FLOOR AREAS
FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT 2,033 6,155 8,188
FIRST
14,120 5,407 19,527
SECOND
7,569 5,053 12,622
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS? 1
TOTAL: 23,722 16,615 40,337
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) 1 GAS LOG(S) REFRIG.SYSTEM(S
BBQ(S) 26 FAN(S) 1 HOOD(S) WOODSTOVE(S)
BOILER(S) 1 FIREPLACE INSERT(S) 1 RANGE(S) MISC. (
COMPRESSOR(S) 2 FURNACE(S)
DUCT(S) 2 GAS PIPE OUTLET(S) HEAT SOURCE: X ELECTRIC X GAS
PLUMBING
BATHTUB(S) 30 LAVATORY(S) I URINAL(S) 2 WATER HEATER(S;
1 DISHWASHER(S) 1 RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC X GAS
1 DRINKING FOUNTAIN(S) 24 SHOWER(S) 2 WASH MACHINE OUTLET
GAS PIPE OUTLET(S) 4 SINK(S) 29 WATER CLOSET(S) MISC. (
1 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,an
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 th
investigation and defense of such claim),which may be made by any person, including the undersigned,and filed against the City o
Federal Way,but only where such claim arises out of the reliance of the city,including its officers and employees,upon the accurac
of the information supplied to the city as a part of this application.
NAME/TITLE: DATE: 3/2301
❑ PROPERTY OWNER X APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
o NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? o YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES o NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES a NO
PLATTED LOT? a YES ❑ NO CHANGE OF USE? ❑YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
Construction Permit Fee Calculation Sheet
*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CITY STAFF PRIOR TO ACCEPTANCE OF PAYMEN1
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)$23.50
(2)$501.00 to$2,000.00 (2)$23.50 for the first$500.00 plus$3.05 for each additional$100.00 or fraction thereof,to and including 52,000.00
(3)$2,001.00 to 525,000.00 (3)$69.25 for the first$2,000.00 plus$14.00 for each additional 51,000.00 or fraction thereof,to and including
$25,000.00
(4)$25,001.00 to$50,000.00 (4)$391.25 for the first$25,000.00 plus$10.10 for each additional$1,000.00 or fraction thereof,to and including
$50,000.00.
(5)$50,001.00 to$100,000.00 (5)$643.75 for the first$50,000.00 plus$7.00 for each additional 51,000.00 or fraction thereof,to and including
5100,000.00.
(6)$100,001.00 to$500,000.00 (6)$993.75 for the first$100,000.00 plus$5.60 for each additional 51,000.00 or fraction thereof,to and including
5500,000.00
(7)5500,001.00 to 51,000,000.00 (7)$3,233.75 for the fist$500,000.00 plus 54.75 for each additional$1,000.90 or fraction thereof,to and including
$1,000,000.00.
(8)$1,000,001.00 and up (8)$5,608.75 for the first$1,000,000.00 plus 53.65 for each additional$1,000.00 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 District#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: $125,000.00
FEE FACTOR FROM TABLE A: Number: 6 (a) Base Fee: $993.75
(b)Additional Increment Fee: $140.00
Estimated Permit Fee: (4) $1,133.75
Estimated Plan Review Fee: (5) $283.44
■ FIRE PREVENTION SYSTEM
PROPOSED VALUATION:
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 Numbgr of Fixtures
$21.00 +{ 96D X$7.00/fixture} = $672.00 (8) Estimated Permit Fee
Estimated Permit Fee
$672.00 X .65 = $436.80 (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)
• ELECTRICAL
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $44.25 _#of Thermostats(First-$33.50;add=n-$10.50e
(First 1300 ft2-$67.00;Each addm 500 ft2-$21.50) Service and feeder $72.25 _#of Low voltage fire or burglar alarms
Square Feet: First 2500 ft2-$38.75;Each adddn 2500 ft2-$10.50
_Each outbuilding or garage $28.00 MOBILE HOME/RV PARK Square Feet:
(Inspected with service) _#of service or feeders *Per WAC 296-46-910(5)(b)(i&ii)
_Each outbuilding or garage $44.25 (First service/feeder-$44.25;Add:n service/ _#of Signs(First sign-$33.50;ad&n sign
(Inspected separately) feeder-$28 each) $16.00 each)
_Progress inspection per 2 hr $33.50
_Swimming pool,hot tub,spa 67.00
Yard Pole meter loops 44.25
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 $72.25
Up to 200 amp $72.25 $21.50 Feeder _201-600 169.00
_201-400 amp 89.75 44.25 _0 to 100 $72.25 $44.25 601-1000 254.50
_401-600 amp 123.25 61.50 _101-200 89.75 56.25 _over 1000 282.75
_601-800 amp 158.00 84.25 _201-400 169.00 67.00 _#of circuits
_Over 800 amp 225.25 169.00 _401-600 197.00 78.75 (1-5 circuits-$56.25;Addl.!circuits,$5 ea)
ALTERED SINGLE/MULTI FAMILY _601-800 254.50 107.25
(When inspected separately from the services.) _801-1000 310.75 129.75 Temporary Service
Service or Feeder _Over 1000 339.00 181.00 _0 to 60 $38.75
_0 to 200 amp $61.50 _Over 600 volts surcharge 56.25 _61-100 44.25
201-600 amp 89.75 _Mast or meter repair 61.50 _101-200 56.25
_over 600 amp 135.25 _201-400 67.00
_Mast or meter repair 33.50 _401-600 89.75
_#of circuits _over 600 97.75
(1-4 circuits-$44.25;Add:n circuits$5 ea)
If service is greater than 200imp,a plan review is req:d.Fee is 35%of permit fee+$56.25.Add:l plan review for other submissions is$67.00/hr.
FIXTURE DESCRIPTION (A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
TOTAL COLUMN (D):
Total Column(D)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $56.25 + X .35 = (13)
• DEMOLITION