02-102976 • RECEIVED
ar.o G CONSTRUCTION PERMIT APPLICATION
uv JUL 1 5 2002
APPLICATION NUMBER: ,- .Zq 7k, -�?�}
CITY OF FEDERAL WA APPLICATION NUMBER: -
BUILDING DEPT. APPLICATION NUMBER: - -
**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: / 7U 3`'SD " ,3,., y2-4-,4-, sj.--- ASSESSOR'S TAX/PARCEL #: ' 5-0 l a c; - D 1 v
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
y -- ''.:' -:.■ .PROTECT INFORMATION--- . • . , . - .. -
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
LI ELECTRICAL LI ENGINEERINGIIIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): 14(5 4 1 - cd-c ii j , S>J7 -7 44
- Tc.(A c N Uts' r 1 0
/6��� t eV)(11(74
PROJECT NAME: / C5-,9,821/6-7671 .Du-14-4171(.17-
.
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
L(kCa Ttc- ( ) -
MAILING ADDRESS(STREET ADDRESS;QTY,STATE,ZIP):
( 7J '7 5E 446t Sr 4-0v6.,
CONTRACTOR: /Ec
DAYTIME PHONE:
/ /yd hij 1 1J //n, �3-lu)71 cr ) C< '' (Q�c) '2/ - 9o�/
MAILIN ADDRESS(STREET ADDRESS;QTY,STATE IP): EVENING PHONE:
v., Q 0>4 d63?" ge`,c t ups 5`�'�� (ate )6�'o -‘0<f,
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: I FAX NUMBER:� �(
(9,2.0 1 3�c `/JL
CONTRACTOR'S REGISTRATION NUMBER: ], �J AEXPIRATION DATE:
(copy of card required) 1. Leo / or { p/ 6-12Z 011o/ / 03
APPLICANT: NAME: DAYTIME PHONE:
(6-0 ,e,) (1/014--)-,77.1 -9,0 j
MAILING ADDRESS
(STREET ADD ;CITY,STATE,ZIP): EVENING PHONE:SE7 ,2 (a ` / sAp s-� (.. O ) 66-3 - 66T-5,
RELATIONSHIP TO PROJECT:
FAX NUMBER:
❑ ARCHITECT ❑ TENANTOTHER(DESCRIBE): (4i ) 3 i,.;/- 11X-
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT Er6ONTRACTOR
11 DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ ' -25-0
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTIO•LY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROTECT FLOOR AREAS •
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
a• :. ..>,�:y ...z..:
,....4ece.totorePaetraiwohoymetielli=FIXTURES.K:.«4:Nir5�:.�: ;.; ;:;, ,: ..44,-.fr.:aa, .:eii.: oris .,a:.
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEI (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) ❑ 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 daim),which may be made by any person,induding 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 supplied to the city as a part of this application.
NAME/TITLE: G L
—� DATE:
❑ PROPERTY OWNER El APPLICANT CONTRACTOR
FOR OFFICE USE ONLY:
E_ - ENANT.IMPROVEMENT'=
' :-❑-NEWS-,�� �❑;�►DDITION; _ ❑ ALTERATION � ,R P11IR a_
:CENSUS
BONING DESIGN�AJIO 3` _ BUILDING SI ELL ONLY? °YES X O "
s' COMP LAN DESIGNATION 'IBASIC PIAN' . . E5 ytTO
a_
1SECTION t `
' = TOWNSHIP!'.'„;,:---RANGE NEW ADDRESS REQUIRED? ❑ YES° `y,❑ NO
T? .....D YES !O :- CHANGE OF USE? _ El YES .. ❑ NO `
PLATTED LO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtyof fedora I wa y.Com
Co*ruction Permit Fee CalculatioSheet
*******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)$26.00
(2)$501.00 to$2,000.00 (2)$26.00 for the first$500.00 plus$3.50 for each additional$100.00 or fraction thereof,to and including
$2,000.00
(3)$2,001.00 to$25,000.00
(3)$78.50 for the first$2,000.00 plus$15.50 for each additional$5000.00 or fraction thereof,to and
including$25,000.00
(4)$25,001.00 to$50,000.00
(4)$435.00 for the first$25,000.00 plus$11.00 for each additional$5000.00 or fraction thereof,to and
including$50,000.00.
(5)$50,001.00 to$100,000.00
(5)$710.00 for the first$50,000.00 plus$8.00 for each additiona/,$1,000.00 or fraction thereof,to and
including$100,000.00.
(6)$100,001.00 to$500,000.00
(6)$1,110.00 for the first$100,000.00 plus$6.00 for each additional$1,000.00 or fraction thereof,to and
including$500,000.00
(7)$500,001.00 to$1,000,000.00
(7)$3,510.00 for the fist$500,000.00 plus$5.50 for each additional$1,000.00 or fraction thereof,to and
including$1,000,000.00.
(8)$1,000,001.00 and up
(8)$6,260.00 for the first$1,000,000.00 plus$4.00 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,commerdal only.
Add$4.50 for WA State Building Code Coundl,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: 1/ 7 f ✓ U
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
$22.50+{ X$8.00/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)