03-103993 ...... .....-&k._._ • EIvD P P4100
,CONSTRIT TIN PERMIT APPLICATION
CITY OF
AUG - /O - 2� 7 zoo3 APPLICATION NUMBER: -eeral Way
APPLICATION NUMBER:
CITBOF FEDERAL LDING DEPT. AY 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. r�� ,-
U PROPERTY INFORMATION '
SITE ADDRESS: l .) / A SESSOR'S TAX/PARCEL #: -
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LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACHS�ARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING 0 ME)HANICAL o DEMOLITION
o ELECTRICAL O ENGINEERING L,fIRE PREVENTION SYSTEM
PROJECT DESCRIPTION A.ro ide .etailed des iption):
PROJECT NAME: . A I` r , k_. 4 ,
miiimmisammilit
■ PEOPLE INFORMATION - . .
PROPERTY OWNER: NAME: ; DAYTIME PHONE
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MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
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CONTRACTOR: ( :::
A r, ee. 0 YT
i IME PH NE: 3
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..••ESS RE ADDRE •STATE,ZIP):
Et1i17G PHONE:Alb ,
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CITY 0 DE• L WAY BUSINESS U NSE NUMBER: FAX NUMBER:
- - ( ) -
CONTRACTOR'S REGISTRATION NUMBER:
I EXPIRA c SATE:
'
(copy of card required) labI 411P , .4.J L _
APPLICANT: NAME: ( / aYTIM PHON
II
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MAILING ADDR..S EET ADDRESS;CITY,STATE,ZIP): « Mr, :•�
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RELATIONSHIP TO PROJECT: j FAX NUMBER:
0 ARCHITECT 0 TENANT ❑ OTHER(DESCRIBE): i ( ) -
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E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT o CONTRACTOR I
U DETAILED BUILDING INFORMATION -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES 0 NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE o TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
dallOction Permit Fel Calculate ipet
*******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$18.00 for each additional 51.00(2 CX)or 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 513.00 for each additional 51.000.00 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$9,07 for each additional 51.000.00 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 57.017 for each additioa/ 1 Or)o 00 or fraction thereof,to and
including$500,000.00
(7)$500,001.00 to$1,000,000.00
(7)$4,079.00 for the fist$500,000.00 plus 1600 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$4.50 for each additional$1,000.00 or fraction thereof.
Bold number Is the base fee for the specified increment
ftalidzed,underlined number'Is the fee ner aedidonatspecified 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)
IL! FIRE PREVENTION SYSTEM
PROPOSED VALUATION: ziocopr 411114,
FEE FACTOR FROM TABLE A: N ber: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
• PLUMBING
Base Fee Number of Wdur s
$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)