02-10289317�(uAed 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: 3G'o1 [-✓1C I�(an4-f't P/<yc j ASSESSOR'S TAX/PARCEL #: 8 a 4
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): r►lC a V< -ke e- Lel i ka G c
Q WA 1P.4 K kC
PRO3ECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
PROJECT NAME:
PROPERTYOWNER:
CONTRACTOR:
IA's �a / � %'I ✓� 10� ✓ ►tit ��5 %` 71 1 . (-"-
/
Cy /(' 1✓
I.�Lv Dlavt�, �->.
A la
NAME:DAYTIME PHONE:
SrX la�als _ erko.VL�ed Packs, 47C,
MAILING ADDRESS (STREET ADD ; CITY, STATE, ZIP):
30jol Ecliamied VidaajPkuiu 5. vecki-eA/ Lia Ia,
N
r; ✓lie C%/ee- fir/ c l e.
DA ME PHONE: .
( 07x(-7 -5"a a o
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, IP):
13 Sol t5L-_ C?(� I
% ooS
EVE NG PHONE:
(CJS) &y -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX UMBER:
(�as )7 417 -ssra
CONTRACTORS REGISTRATION NUMBER:EXPIRATION
i' i2 M E1
r 3 r
DATE:
o 1 / 30 /a 0cZ3
(copy ��,drequired)
APPLICANT: NAME:DAYTIME PHONE:
1�r1`✓�Q ifc �-Y('( 14 C' (gc)Sj 7y-1 -5ao0
MAILING ADDRESS (STREET ADDRESS; CITY, +SSTTA , ZIP): EVENING PHONE:
'3 3t-71 5 E (� N't iS r c U �(� /- 9,5005 N2a -) 96 el -
RELATIONSHIP -
TO PROJECT: (W -OTHER
' I FAX NUMBER, /
❑ ARCHITECT ❑ TENANT -OTHER ( DESCRIBE): (DVI tyo-cs z r (�d� ) 7 'i 7
E-MAIL ADDRESS: 11
CONTACT PERSON FOR THIS PROJECT: El PROPERTY OWNER APPLICANT X CONTRACTOR ," I vi rv1 e e (e Irl'
DETAILED BUILDING
• •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE (SEPTIC)
<OK4I
**NEW RESIDENTIAL CONSTRUCTION LY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Y ■ PROX" FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
FIRST
NEW ADDRESS REQUIRED? ❑ YES ❑1NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ .: 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 ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHERS) RAIN WATER SYS. VACUUM BREAKER(S) ElELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. ( )
INTERCEPTOR(S) SUMP(S)
!iT4-tCt-ATMPD/4mTCNATl1RF RI r
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 person, including 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: l�i�.2 G��r �O �'?i}" / /'� �' in� C CCf�4�i(� ✓IGI Dr -
El
✓
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
DATE: Jv l�� li �L7Oo2
❑ NEW ❑ ADDITION ❑ ALTERATION
- ❑ REPAIR El TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
.ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION ,TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑1NO
PLATTED 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
CoPruction Permit Fee CalculatiorRheet
*******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 $1.27 for eadi additiorml $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 $1500 foreach odditiona1SI,000.00or
fraction thereof, to and induding
$25.000-00
(4) $25,001.00 to $50,000.00
(4) $403.61 for the first $25,000.00 plus SIO.82 for eafi additional
$1.000.A7or fraction thereof, to and induding
$50,000.00.
(S) $50,001.00 to $100,000.00
(S) $664.35 for the first $50,000.00 plus $750 far each additions/
51,000.00 or 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
adbibonal$1,000.00or fraction thereof, to and induding
$500,000.00
(7) $500,001.00 to $1,000,000.00
(7) $3,337.23 for the fist $500,000.00 plus $509 for eadr
additional $1,000.00or fraction thereof, to and induding
$1,000,000.00.
(8) $1,000,001.00 and up
(8) $5,788.23 for the first $1,000,000.00 plus 53.91 for each
additional $1,000. or fraction thereof.
Bold number is the base fee for the spedited increment
•
Italicized, underlined number 7s the fee per additional speed
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:
Estimated Permit Fee: (1
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (4
Estimated Plan Review Fee:
(a) Base Fee:
(b) Additional Increment Fee:
(a) Base Fee:
(b) Additional Increment Fee:
PROPOSED VALUATION: a J K )o- CSO
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee: i5- Co G K of
Estimated Permit Fee: (6)
Estimated Plan Review Fee:
Base Fee Number of Fixhues
$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 (Pageone): Line(s)(1)+(2)+(3)+(4)4-(5)+(6)+(7)+(8)+(9)+(10) = (11)