01-104270**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.
DRnDFRTV TNFnRMATTC
SITE ADDRESS: U C L J ASSESSOR'S TAX/PARCEL #: ` ` 7 �a 0— DO p) ,
�w 1 c).g ---
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application):
PROJECT DESCRIPTION (Provide detailed
PROJECT NAME:
PROPERTY OWNER:
14141 rT:s_TiIto] ;t
APPLICANT:
Du
■ PR03ECT INFORMATION
❑ BUILDING ❑ PLUMBING AMECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
'YI
■ "PEOPLE INFORMATION
LA
NAME: DAYTIME PHONE:
l / u a ( l (Z3) �F35 -/�
MAILING ADDRESS ( ,STATE, ZIP):Is J -k
NAME: � Q
DAYTIME PHONE:
q
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
/
(Copy of card required)
2-1 Z 3 r Z
NAME:
(z'�-% 3) LZq -L/o
MAILING ADDRESS (STREET ADDRESS; CIIY1 STATE, ZIP): EVENING PHONE:
J ( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
❑ NO
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
SHOWER(S)
GAS PIPE OUTLET(S)
SINK(S)
FIRST
SUMP(S)
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 fixturea,= -
� 0 1.
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)
DISHWASHERS)
RAIN WATER SYS.
DRINKING FOUNTAIN(S)
SHOWER(S)
GAS PIPE OUTLET(S)
SINK(S)
INTERCEPTOR(S)
SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
WATER HEATER(S)
ElELECTRIC ❑ GAS
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 appli
NAME/TITLE: -51�1 �r C /�G�l DATE:
❑ PROPERTY OWNER ❑ AP*ANT J<CONTRA&O
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
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 13.27for eadr additi2na11100.00 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 $15.00 fareadr additional
$1,000.00 or fraction thereof, to and including
$25,000.00
(4) $25,001.00 to $50,000.00
(4) $403.61 for the first $25,000.00 plus 510.82 for each additional
$1 000 CO or fraction thereof, to and induding
$50,000.00.
(5) $50,001.00 to $100,000.00
(5) $664.35 for the first $50,000.00 plus 17.50 far each additioml
$1 000 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 1600 (preach additional
$1 000 OO or fraction thereof, to and including
$500,000.00
(7) $500,001.00 to $1,000,000.00
(7) $3,337.23 for the fist $500,000.00 plus 1509 fix each addibenal
$1 000 00 or fraction thereof, to and including
$1,000,000.00.
(8) 51,000,001.00 and up
(8) $5,788.23 for the first $1,000,000.00 plus $3.91 foreadr
addibbnal $1 000.00or fraction thereof.
Bold number is the base fee for the specified increment
Italicized underlined number is the lee per additional specified
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 **
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee:
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (
Estimated Plan Review Fee:
■ BUILDING
(a) Base Fee:
(b) Additional Increment Fee:
(a) Base Fee:
(b) Additional Increment Fee:
u �.. v ■ FIRE PREVENTION SYSTEM
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
Base Fee Number of Fixtures
$21.00+( X $7.00/fixture} _ (8) Estimated Permit Fee
Estimated Permit Fee
X .65 =
Miscellaneous Fixture Charge: (10)
Sub Total (Pageone): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)
(9) Estimated Plan Review Fee
TABLE B
RESIDENTIAL SERVICES
MOBILE HOMES
MISC EQUIPMENT/TEMP SERVICES
Single Family
_Service or feeder only .........................
$48.00
# of Thermostats (First -$36.00; add'n-$11.00ea)
(First 1300 ft' -$72.00; Each add'n 500 ft
-$23.00)
Service and feeder ...............................
$78.00
# of L.ow voltage fire or burglar alarms
[NEW
uare Feet:
First 2500 ft' -$42.00; Each add'n 2500 ft -$11.00
Each outbuilding or garage ...........................
$30.00
MOBILE HOME/RV PARK
Square Feet:
(Inspected with service)
# of service or feeders
• Per WAC 296116-910(5)(b)(i & ii)
Each outbuilding or garage ...........................
$48.00
(First service/feeder-$48.00; Add'n service/
_ # of Signs (First sign -$36.00; add'n sign
(Inspected separately)
feeder -$31 each)
$17.00 each)
_ Swimming pool, hot tub, spa .................72.00
Yard Pole meter loops ...........................48.00
NEW MULTI -FAMILY
COMMERCIAL/INDUSTRIAL
COMMERCIAL/INDUSTRIAL
(Includes three units or more)
Altered Service or Feeders
Service
Feeder
Amps Service or
Add'n
_ 0 to 200 ..............................................$ 78.00
Up to 200 amp .............. $ 78.00 ................
$ 23.00
Feeder
_ 201-600 .............................................. 182.00
201 - 400 amp .................. 97.00 ....................
48.00
_ 0 to 100.........................$ 78.00.......
$ 48.00
601-1000 ............................................ 274.00
_
401- 600 amp ................ 133.00....................
66.00
_ 101-200 .......................... 97.00
........... 61.00
_ o r 1000 ............................................. 305.00
_
601 - 800 amp ................ 170.00 ....................
91.00
201-400 ........................ 182.00
........... 72.00
1 # o circuits
_
Over 800 amp ................. 243.00 ..................
182.00
_
401-600 ........................ 212.00...........
85.00
ircuits-$61.00; Add'n circuits, $5 ea)
_
ALTERED SINGLE/MULTI FAMILY
_
_ 601-800 ........................ 274.00.........
116.00
(When inspected separately from the services.)
_ 801-1000 ...................... 335.00.........
140.00
TEMPORARY SERVICE
Service or Feeder
-Over 1000 ...................... 365.00.........
195.00
Residential/Multi-Family/Commercial/Industiral
0 to 200 amp ................................................
$ 66.00
_ Over 600 volts surcharge ......................
61.00
_ 0-100 .................................................... 48.00
_
_ 201 - 600 amp ................................................
97.00
_ Mast or meter repair..............................
66.00
_ 101-200 ................................................ 61.00
_ over 600 amp ................................................
146.00
_ 201-400 ................................................ 72.00
Mastor meter repair .......................................
36.00
_ 401-600 ................................................ 97.00
# of circuits
_ over 600 ...............................................105.00
_
(IA circuits -$48.00; Add'n circuits $5 ea)
If service is greater than 200 amp, a plan review is req'd. Fee is 35% of permit fee +$61.00. Add'l plan review for other submissions is $71.00/hr.
WF "P.EDESCRIPTION A ,"`: TFIXTURE 1E''FROM TABLE B' B -.x rxNUMBER OFMNITS. C 4 a* TOTAL D . f
TOTAL COLUMN D):"
Estimated Permit Fee: (
Estimated Plan Review Fee: $56.25 +
Estimated Permit Fee: (1
Bond Amount: (15)
Estimated Permit Fee: (16)
Bond Amount: (17)
Mitigation Fee: (18)
SBCC Surcharge: (19)
Total Column (D)
Estimated Permit Fee from hne 12
■ DEMOLITION
_,. 1. - .: ■ OTHER FEES
X.35 = (13)
(20) (22)
(21) (23)
TOtal (pages one &Tvo): Une(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) = (24)
Bulletin #100 - August 20, 2001