02-101268 .a
� G_ tECEIVED CONSTRU�N PERMIT APPLICATION
uV Fn.,-moi-- ,PPLICATION NUMBER: O, L 1 2- � CO
MAR 2 6 2002 .PPLICATION NUMBER:
,,'•LIGATION NUMBER:: ti
CITY OF FEDERAL W'
**The followit*1Lait r$'tgro1\
•tion—P1: :se print(in ink)or type**
Please note: Electrical,Fire Prevention Systems an nginee ' g permits may require a separate application.
• <"%tOPERT, Mr,RMATION .
SITE ADDRESS: 180 1 S 282..ND • 'E r ASSESSOR'S TAX/PARCEL#: 3 3 2. 2 O Y - 9 6 $ I-oei
LEGAL DESCRIPTION OF SU I P •P ', ATTA S ' • •TE DESCRIPTION IF LENGTHY): S E t: / 'rrAG He'D
r
i IIII\
_-, a PROJECT INFORMATION -
TYP* PROJECT ' is applica- .n): J2t UILDING PLUMBING lir MECHA CAL 0 D 4 OLITION
0 ECTRICAL ENGINEERING P ' ENTION S'STEM
PROJECT DESGRIPTION(Provide de :• . • • .ti• '): C HA N . A RT HE NT' LW E LL l N(
TO DAYCARE FAc,tc. , `' 1E ►VE Rio \ ;, , ADD N /Fcc& si346-
To/LET ROot`4 ADD NEt.v EX ' Voo ' Si ) sTALt, New F6 4 FKTERfok,
OlrYL,rZE 15 Iioto SF itri:, Se R,- III* #t• ►•E .
PROJECT NAME: 0 C.,EA N R ID CA 'C j 2 6
- . - . 1_;P► 'JPLE INFORMATION -
op-
PROPERTY OWNER: NAME DAYIIME PHONE:
I .c. • i , (r +v SING t44NLt PeoC R..4 t NG 68 - 16so
LING H.
• ADDRESS: ,STATE,ZIP):SSiST
'k E. CASSeL 99- ( - cj )9&
CONTRACT • NAME. DAYTIME PHONE:
( ) -
LING ADD•: .(STREET ADD , TE,• EVENING PHONE:
CITY OF'o. • , AYNUM • FAX NUMBER:
Aillit'
-
CO TI UMBER EXPIRATION DATE:
APV /
/
APPLICANT. E' DAYTIME PHONE:
) . •24 Cst?ow. J /oc i Pe ve / Rcr T6rS
(206) 52 -`-13s6
MAI ADDRESS( •- ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
Si 6 UN EgSJTy Why NE, SEA-r1-1,6,VM 981oy ( ) -
RELATIONSHIP TO PROJECT: FAX NUMBER:
14 ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): (ZOO 52 c/ - O2 Cr,
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER jig APPLICANT 0 CONTRACTOR georjeC Veloc,•pe.het
_ R DETAILED BUILDING INFORMATION
EXISTING USE: RESIOENPAC. _ EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ C.3 M ILL/OA/
PROPOSED USE: DAYCifer0wS PROPOSED VALUATION FOR IMPROVEMENTS: $ IS 3,00 0 .00
SPRINKLERED BUILDING? ❑ YES N NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES f/
WATER SERVICE PROVIDER: 'LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: PJ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
# r • #
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
111 ■ PRO]ECT FLOOR AREAS
FLOOR EXISTING SQ.FT, PROPOSED SQ.FT. TOTAL
BASEMENT J,
FIRST 1/00(0 SF 1,000 SF ,/ c300 Sr
SECOND (4
THIRD
FOURTH Aif/4
OTHER FLOORS(DESCRIBE) N/A
DECK N/,
GARAGE
HOW MANY FLOORS? /
TOTAL: , 000 S F '� Oc)0 SF ), 066 S F
1
•
:_■ FIXTURES
Indicate number of each type of fixture
MECHANICAL
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: ELECTRIC 0 GAS
PLUMBING
BATHTUB(S) V ' �LAVATORY(S) URINAL(S) 1 WATER HEATER(S)
r1 DISHWASHER(S) RAIN WATER SYS. V•I UM BREAKER(S) kr ELECTRIC 0 GAS
DRINKING FOUNTAIN(S) S OWER(S) MACHINE OUTLET
GAS PIPE OUTLET(S) S) e_ • ER CLOSET(S) MISC.( )
INTERCEPTORS) MP(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 daim(induding 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 daim arises out of the reli••ce of the dty,induding its officers and employees,upon the accuracy
of the information supplied to the a as a part of this ap. cats•n.
NAME/TITLE: / DATE: ( -} K-a> *7—'4'2—
E1
''"Z❑ PROPERTY OWNER XAPPLICANT 0 CONTRACTOR
wojtVEKMMEONWINI
0 NEW ADDITION ❑=ALTERATION ``IC REPAIR A❑TENANT IMPROVEMENT . . ;'
•
C£NSUS GLIDE _ COT SIZE:
ONI G ,ESIGNATIO(V. ;;a _ BUILDING_SHELL.ONLY?A ❑.YES .❑-NO
ICOM DESIGNATION BASIC PLANfA'=❑YES'T _ ❑. O
,SCTION ,_TOWNSHIP RANGE NEW ADDRESS REQUIRED ❑ YES NO ,
LATTED`LOT?._..':_❑YES ❑ NO CHANGE OF.USE?: . ! ❑YES .❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO 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 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)$24.25
(2)$501.00 to$2,000.00 (2)$24.25 for the first$500.00 plus$3.27 for each additional$100.00 or fraction thereof,to and Including$2,000.00
(3)$2,001.00 to$25,000.00 (3)$71.46 for the first$2,000.00 plus 515.00 fix-eachackfidona/$1.00000 or fraction thereof,to and Inducing
$25,000.00
(4)$25,001.00 to$50,000.00 (4)$403.61 for the first$25,000.00 plus$10.82 for each additional SL000.00or fraction thereof,to and Including
$50,000.00.
(5)$50,001.00 to$100,000.00 (5)$664.35 for the first$50,000.00 plus$Z50 for each additional S1.000.00or fraction thereof,to and Including
$100,000.00.
(6)$100,001.00 to$500,000.00 (6)$1,025.55 for the first$100,000.00 plus$6.00 for each additional$1.0100.00 or fraction thereof,to3nd including
$500,000.00
(7)$500,001.00 to$1,000,000.00 (7)$3,337.23 for the fist$500,000.00 plus$5.09 for each additional SL000.00 or fraction thereof,to and including
$1,000,000.00.
(8)$1,000,001.00 and up (8)$5,788.23 for the first$1,000,000.00 plus$3.91 far each arlaGtional SI.000.00or fraction thereof.
Bold number is the base fee for the specified inaement
Jta/Idzed,underlined numbers the fee per additional spedfiedIncrement
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 Fre District#39 surcharge,commercial 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: S 11000
FEE FACTOR FROM TABLE A:Number. t 5 (a)Base Fee: GC,CI •_
_ (b)Additional Increment Fee: 7 a=)
Estimated Permit Fee: (1) t
Estimated Plan Review Fee: (2) • --
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
._ - : ■ MECHANICAL
PROPOSED VALUATION: 2, 000
FEE FACTOR FROM TABLE A:Number. ( (a)Base Fee: 3 i,
(b)Additional Increment Fee: • 00
Estimated Permit Fee: (4) 7.i/-q(0
Estimated Plan Review Fee: (5) 13
:. :. _ : ._._.,<:..■ FIRE PREVENTION SYSTEM
PROPOSED VALUATION: d, .
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 o_f Factures
$21.00+{ X$7.00/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)