03-101562tECEIVED
►
L ,1CONSTRUCTION PERMIT APPLICATION
CITY OF APR 2 2 2003PPLICATION NUMBER::; - - f I
Federal Way CITY NUMBER: _ _ - - - - - _ _ - _ -
BUILDING DEPT
CITY FEDERAL WAY APPLICATION NUMBER:
L- - - - - - - - - -
**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•• •
SITE ADDRESS: _� (>m 1-r.c>hn r�� 1. �<<W �-y S ASSESSOR'S TAX/PARCEL #: �i�, of I - C Q t✓
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING)( FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION Provide detailed description): /nJfa "V" / >r,
+roM Jc.JJin�
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PROJECT NAME:
PROJECT•• •
PROPERTY OWNER:
CONTRACTOR:
NAME: I DAYTIME PHONE:
MAILING ADDRESS (STREET RESS; CITY, STATE, ZIP):
,
NAME: {-'
DAYTIME PHONE:
MAILING ADDR SS (ST ET ADDRESS; CITY, STATE, ZIP):
1� . O . 17A ') c }-�.cle,r�l VUR
WA 9 306
EVENING PHONE:
-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
�o-_��_� o
FAX NUMBER:
d63)F3F-0)013
CONTRACTOR'S REGISTRATION NUMBER:
L L_ *
�i, 4
EXPIRATION DATE:
4/ / /- / z00%
(copy of card required)
APPLICANT: NAME: / DAYTIME PHONE:
—)r-rr;Q, 6k� Corrlrm-jor ( ) -
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER a APPLICANTCONTRACTOR
PROJECT• •
EXISTING USE:
PROPOSED USE:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
SPRINKLERED BUILDING? YES ❑ NO
WATER SERVICE PROVIDER: �LAKEHAVEN
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN
PROPOSED VALUATION FOR IMPROVEMENTS: $ 15, ow
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
'�*NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT 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 ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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) FIREPLACEINSERT(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)
BLOCKN DISCLAIMER/ SIG NATURE
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: F'/e J'C--7I �i., .� — `"� r DATE:
❑ PROPERTY OWNER ❑ APPLICANT X CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ 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 ❑ NO
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
www. cityoffederalway.com
•
•
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.
PLUS:
TARI F 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 $4.00 for 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 $1,000.00 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 $13.00 for each additional $1,000.00 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 $9.00 for each additional $1,000. 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 $700 for each additional $1,000.00or 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 $6.00 for each additional $1,000.00 or fraction thereof, to and
including $1,000,000.00
(8) $1,000,001.00 and up
(8) $7,079.00 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
Italicized, underlined number is the fee Per additional specified increment
r.uu o� ui Yne ud�e uwwuiy pernm iee for pidn review Yee.
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 **
0 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)
(a) Base Fee:
(b) Additional Increment Fee:
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
PREVENTION14 FIRE
PROPOSED VALUATION:O Vy
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee: I
Estimated Permit Fee: (6) rt i
G�
Estimated Plan Review Fee: (7)
PLUMBING
Base Fee Number of Fixtures
$26.00 + { X $9.00/fixture} _ (8) Estimated Permit Fee
Estimated Permit Fee
X .65 =
Miscellaneous Fixture Charge: (10)
Sub Total (Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)
(9) Estimated Plan Review Fee