06-106095 lilt:
I Federal WaYINSUBMITTED ( O '� 0
3 o Zoo PERMIT SF MF CO MELJPL DE EN FP
COMMUNITY DEVELOPMENT SERV! ��
33325 D AVENUE.WA 9•PO BOX A`t L I C AT I O N � _ /
FEDERAL WAY.WA 98063-9718 �
253-835-2607•FAX 253-8352609 J
t'ww.cTh o(jederulty OF FEDERA a-
V� �:I�J I G DEPT.
The ollowin, is re• i ormation-an incom'Tete a',lication will not be acce s ted. Please 'rint le•ibl (in ink)or , •.
1 5'T .cT 17• PROPERTY INFORMATION
SITE ADDRESS (�,1 0 1 S. 3�-��// H- aSUITE/UNIT# I 07-
ASSESSOR'S TAX/PARCEL# 0 c 9 c - O U 9 Z LOT SIZE(s)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
. IN PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION X ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
(NI5TA-l.t_Al lc,o ) C ADO.Ttw.i TO i-ii tot M 54gre M
PROJECT NAME(Name of Business or Owner Last Name) /1/�/>1S(:,✓'1`/f r' „,,. y
• PEOPLE INFORMATION •
PROPERTY NAME PRIMARY PHONE
OWNER t1 QS (j ) !-LC (42S )q - q/UC-
MAILING ADDRESS CITY,STATE,ZIP
9/s /187-0- A-✓4 Se _S-017-- 300 (3>Ec.c.Ievu , L-4)4 '8(
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
PC C C IF(�x SEurs.-;y Tm f4si.��ar) ( 2-c( ) 7 S a -380(c
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
610 t)o 2 Pl.44 S . S,;A,-r - WA 98iv'( ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Z o - D 2 - / O 5 ' 7 - B L / / ('ZO(o )726 - 8/(pO
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
P A c f F F S (t L 3 2 0 /a /3o 6 7
APPLICANT COMPANY NAME ( r APPLICANT NAME OFFICE PHONE
PACI FCC Flak. 3iecu!14.11 l c. -77N1 l #tTnoW (zcG.,)78' - 3$'G
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
6Z ,ilikAl2 s , wA 56/1/y ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent 0 Other(Describe) CtY 77 C- Z/YZ (2 c'' ) "7Z4 - V1400
CONTACT NAME PRIMARY PHONE E-MAIL ADDRLSS
11-CiiiT V7/N' (zA.14, ) 78k- - 380(0 . 6-4e 0 Pc's.6z
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 10 HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower combo) SHOWERS WATER CLOSETS('oiled MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
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 claim),which may be made by any .erson,including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reliance of the a cit., ' luding its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.. -
..„
NAME/TITLE 171a!(1ain DATE • 1
�••+:,P�a�n,�n wv —�� (Title)
RELATIONSHIP TO PROJECT 0 Owner ❑ Agent C\Contractor ❑ Architect 0 Other
FOR OFFICE USE ONLY
❑NEW o ADDITION u ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES a NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Pemvt Application
1111117
T
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder Each Add'n
❑ Single Family Square Feet
(First 1300 ftz-$107.50;Each add'n 500 ft2-$34.50) ❑ 0 to 100 amp $117.00 $71.50
❑ Detached outbuilding or garage ❑ 101-200 amp 145.00 91.50
(Inspected with service) $45.50 ❑ 201-400 amp 272.00 107.50
❑ Detached outbuilding or garage ❑ 401-600 amp 317.00 127.00
(Inspected separately) $71.50 ❑ 601-800 amp 410.00 173.50
O 801 - 1000 amp 500.50 209.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 546.00 291.00
Service Feeder
❑ Up to 200 amp $117.00 $34.50 U Over 600 volts surcharge, $91.50
❑ 201 -400 amp 145.00 71.50 ❑ Mast or meter repair $99.00
❑ 401 600 amp 198.50 99.00 ALTERED COMMERCIAL/INDUSTRIAL
0 601 -800 amp 254.00 136.00
❑ Over 800 amp 364.00 272.00 Service or Feeders
❑ 0 to 200 amp $117.00
ALTERED SINGLE/MULTI FAMILY U 201 -600 amp 272.00
❑ 601 - 1000 amp 410.00
Service or Feeder ❑ over 1000 amp 456.50
❑ 0 to 200 amp $89.50
❑ 201 -600 amp 145.00 ❑ #of circuits to be added/altered
❑ over 600 amp 218.50 (1-5 circuits-$91.50;Add'n circuits,$7.00/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$71.50;Add'n circuits$7.00/ea) $91.50 plus 35%of Permit Fee
❑ Service- 1,000 amps or greater
❑ Mast or meter repair $53.50 ❑ Medical/Educational/Institutional Facility
MOBILE HOMES
❑ Service or feeder only $71.50
❑ Service and feeder $117.00
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/Multi-Family $63.00
❑ #of service or feeders
(First service/feeder-$71.50;each add'n-$46.50) Commercial/Industrial Service or Feeder Ampacity
❑ 0- 100 amps $71.50
U 101-200 amps 91.50
❑ 201-400 amps 107.50
❑ 401-600 amps 145.00
❑ over 600 amps 157.00
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats ❑ #of Signs
rte (First-$53.50;add'n-$16.50/ea) (First sign-$53.50;add'n sign$25.00/ea)
Low Voltage • ❑ Swimming pool/hot tub $107.50
ware Feet to be served by system(s) 1..z (Includes additional circuit,if required)
Fire Alarm System ❑ Yard Pole meter loops $71.50
❑ Security Alarm System ❑ Additional Plan Review $107.50/hour
❑ voice Cabling (for modified submittals)
❑ Data Cabling
U Automation Fee on all Permits .. $5.00
(Per System(s) tat 2500 ft2-$63.00;
Each add'n 2500 ft2-16.50) •Per WAC 296-46-910(5)@)(t&U)
Bulletin#100-January 1,2006 Page 3 of 4 k\I-Iandouts\Permit Application
FEES
This is an overview of possible fees associated with the issuance of permits and is not intended to be inclusive.
PERMIT FEES
Building,mechanical,and fire prevention system fees are based on the following schedule.
**Electrical and plumbing fees are calculated separately**
TOTAL PROJECT VALUATION INCREMENTAL FEE FACTOR
(1)$1.00 to$500.00 (1)$32.00
(2)$501.00 to$2,000.00 (2)$32.00 for the first$500.00 plus$4.00 for each additional$100.00 or fraction thereof,to and
including $2,000.00
(3)$2,001.00 to$25,000.00 (3)$92.00 for the first$2,000.00 plus$19.00 for each additional$1,000.00 or fraction thereof,to and
including$25,000.00
(4)$25,001.00 to$50,000.00 (4)$529.00 for the first$25,000.00 plus$13.50 for each additional$1,000.00 or fraction thereof,to
and including$50,000.00
(5)$50,001.00 to$100,000.00 (5)$866.50 for the first$50,000.00 plus$9.50 for each additional$1,000.00 or fraction thereof,to
and including$100,000.00
(6)$100,001.00 to$500,000.00 (6)$1,341.50 for the first$100,000.00 plus$7.50 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)$4,341.50 for the fist$500,000.00 plus$6.50 for each additional$1,000.00 or fraction thereof,to
and including$1,000,000.00
(8)$1,000,001.00 and up (8)$7,591.50 for the first$1,000,000.00 plus$5.00 for each additional$1,000.00 or fraction thereof.
Table A
PLAN REVIEW FEES
• Building Permit 65% of Building Permit Fees
• Mechanical Permit 25% of Mechanical Permit Fees
• Plumbing Permit 65% of Plumbing Permit Fees
• Additional Building Division Review $65.50/hour
PLUMBING PERMIT FEES
• $27.50 Permit Fee plus $9.50 per fixture
OTHER FEES (Vary according to project type and scope)
• WA State Building Code Council (SBCC) Surcharge $4.50/issued permit
• Fire District #39 review fees (commercial only) 15% of building permit fees
• Public Works review fees Hourly/varies by project
• School District impact fees (new residential only) $3,526.50/single-family residence
$940.00/multi-family unit
• Automation fee on all permits $5.00
• Demolition permit fees
• Required bond(s)/deposits
If you need assistance completing the permit application form, or have questions
concerning the application process, please contact:
Community Development Customer Service Counter at (253) 835-2607
8:00 am to 5:00 pm, Monday through Friday
Bulletin#100-January 1,2006 Page 4 of 4 k\Handouts\Permit Application