01-102589 crTror CONSTRUCTION PERMIT APPLICATION
VV FAYRECEIVE,
APPLICATION NUMBER: 0 I 1 _t 1 f q - 1 7,,,
RECE\V APPLICATION NUMBER: - 1
APPLICATION NUMBER: -
**The following is required-information-Please print(in ink)or type**
Please note: Electrical, Fire Preve t 4 f1 } Yneering permits may require a separate application.
:• :v - - . ■ PROPERTY
ryINFORMATION
SITE ADDRESS: 4 t V ? ✓ ASSESSOR'S TAX/PARCEL #: i 7 Z 1 09 / 5
LEGAL DESCRIPTION OF SUBJECT PROPERT PARATE DESCRIPTION IF LENGTHY):
,"- . • ■ PRO]ECT INFORMATION =
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
N"LLECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJEc.TDESCRIPTION (Provide detailFd description): Rt__ W t re)--L-(-(e---k-t 1.-0As L
-
e --Vz--(..e ( p9- xdcic
PROJECT NAME: cC4_ T 1 Cl -S 4 I ' e_/(C S' c4' f Id rn i • "s
•
- . . • ■ PEOPLE INFORMATION . •
PROPERTY OWNER: NAME: DAYTIME PHONE:
I. G 174C- ► - i 6.-- ( ) °I Z7 I %De
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): 4
S-7 3
' 5 sF
/ 5-0 r--- : ck) s 9SOD
CONTRACTOR: NAME: DAYTIME PHONE:
x1-2._t— - .P. --% C (2S"s53c- / goo
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
°15VS ICI \ J C / LZS606) - 65 ` ?
CITY OF FEDEfRAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: '
- - (25-4j 5357 ler (1
.APPLCONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) L A Z C iZ 1 0 3 3 b E ./ / C).-
APPLICANT:
ICANT: NAME: SS ((,��'OO"" DAYTIME P"`/HONE:
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 ❑ APPLICANT _CONTRACTOR
. - - . ■ DETAILED BUILDING INFORMATION S • - • - -
EXISTING USE: V 1 Q e EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ / 0000 °C) 0
PROPOSED USE: 0 Cf i c` PROPOSED VALUATION FOR IMPROVEMENTS: $ 2 00 O
SPRINKLERED BUILDING? ❑ YES /NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES
WATER SERVICE PROVIDER: • HAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
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!*******
Budding, mechanical,and fire prevention system fees are based on the following schedule.
TABLE A
TOTAL VALUATION FEE FACTOR
(1)51.00 to$500.00 (1)124.25
(2)5501.00 to$7,000 CO (2)124.25 for the first 1500.00 plus S1.L7fiv L'_tih,xhL!<vyll5IQQ QQor fraction thereof,to and including 12,000.CO
(3)52,001.00 to 525,000.00 (3)571.46 for the first$2,000.00 plus 51$fk2 ,fv_c,2ch a4Ifti rkiLf2,(W Ai or fraction thereof,to and including
$25,0[0.00
(4)525,001.00 to 550,000.00 (4)1403.61 for the first 125,000.00 plus 112$;12L cacti,rtfil(t!Qfkrl$1,000 Rio,frxtu.n thereof,to and includ.ng
550,000.00.
(5)550,001.00 to 5100,000 00 (5)1664.35 for the first$50,000.00 plus 57.5.Q.11r e.Kh atkig. argil QQQ.QQ or fraction thereof,to and iIKludmg
$100,000.00.
(6)5100,001.00 to 5500,000.00 (6)11,025.55 for the first$100,000.00 plus 56 00 for edChyrjsti0viai.f1_( Q0Qor fraction thereof,to and including
$500,000.00
(1)$500,001.00 to 51,000,000.00 (I)$3,337.23 for the fist$500,000.00 plus 5524 for eac adclgicvl,Kfl QOQQQof(ration thereof,to and including
51,000,00!7.00.
(8)51,000,001 00 and up (5)15,788.23 for the first$1,000,000.00 plus 539/ftv_e,Kh.-oot0f (f1,0000Q or 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 4'39 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: _ (a)Base Fee: _
(b)Additional Increment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
. . . . .- ■4 MECHANICAL
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
- ■ 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)
. • PLUMBING • - . -
Base Fee Number of Fixtures
$21.00 + { X$7.00/fixture} = (8) Estimated Permit Fee
Estimated Permit Fee
X .65 = (9) Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
••NEW RESIDENTIAL CONSTRUCTION ONLY"•
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
•
. .. - ' ■ :PROJECT FLOOR AREAS ." -
FLOOR EXISTING SQ. FT. PROPOSED sq. FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH — -------- - - - - -
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
... ,1'..:4-''.::•i* .I '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 Li GAS
I
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)
. , . :: .:-• DISCLAIMER/SIGNATURE BLOCK .
I c ify under penalty of pe u that the information furnished by me is true and correct to the best of my knowledge,and
further,that am authorized by the o ne ofthe above premises to perform the work for which the permit application is made. I
further agree o . . har less the Ci of F.dera . as to any claim (including costs, expenses,and attorneys'fees incurred in the
investigation a,d se -nse of such clai ),wh.ch , ay b . . by any person, including the undersigned, and filed against the City of
Federal Way, b • I wh- e such clai aris3;., • • re I. ce of the city, including its officers and employees, up n the accuracy
of the informatio` \up0li\• to t�• city •:�� i • p.- `
NAME/TITLE: iA. _ 1�� ``1 jl`��U�/� DATE: c g...�
❑ PROPERTY OW • ❑ APPLICANT ❑ 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? El YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? 0 YES ❑ NO
. • ELECTRICAL '
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
- _a of Thermostats(First-$33.50;add'n-$10.50ea)
Sin^_Ic Family -Service or feeder only $44.25
l
(First 1300 ft2-S67.00;Each add'n 500 ft'-$21.50) _Service and feeder $72.25 _a of Low voltage lire or burglar alarms
tint 2500 I1'-538.75;Each add'n 2500 ftt-510.50
Square feet:
_Each outbuilding or garage 528 00 MOBILE HOME/RV PARK Square Feel
(Inspected with service) _#of service or feeders • I'er WAC 296-46 910(5)(b)(i&ii)
_
Each outbuilding or garage $44 25 (First service/feeder-$44.25;Add'n service/ _S of Signs(First sign-$33.50;add'n sign
(Inspected separately) $16 00 each)
(ceder-$28 each) _Progress inspection per 1/2 hr $33.50
_Swimming pool.but tub.spa 67.00
Yard Pole meter loops 44.25
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 $72.25
-Up to 200 amp $72.25 $21.50 Feeder -201-600 169.00
_201 -400 amp 89.75 44.25 _0 to 100 S 72.25 $44.25 _601 - 1000 154.50
_401 -600 amp 123.25 61.50 _ 101-200 89.75 56.25 _over 1000 282.75
_601 -800 amp 158.00 84.25 _201 -400 169.00 67.00 _a ofcircuits
_Over 800 amp 225.25 169.00 401 -600 197.00 78.75 (I-5 circuits-556.25:Add'n circuits.$5 ca)
ALTERED SINGLE/MULTI FAMILY 601 -800 254.50 107.25
(When inspected separately from the services.) 801- 1000 310.75 129.75 Temporary Service
Service or Feeder Over 1000 339.00 181.00 _0 to 60 $38.75
_0 to 200 amp $61.50 _Over 600 volts surcharge 56.25 _61 - 100 44.25
_201-600 amp 89.75 _Mast or meter repair 61.50 _101 -200 56.25
_over 600 amp 135.25 _201 - 300 67.00
Mast or meter repair 33.50 _401 -600 89.75
over 600 97.74
_#of circuits -
(1-4 circuits-544.25;Add'n circuits$5 ca)
If service is greater than 200 amp,a plan review is req'd.Fee is 35%of permit lee+$56.25.Add'I plan review for other submissions is$67.00/hr.
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
TOTAL COLUMN(D):
Total Column(0)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $56.25 + X .35 = (13)
IN DEMOLITION -
Estimated Permit Fee: (14)
Bond Amount: (15)
•
- . . • • ■ ENGINEERING . -
Estimated Permit Fee: (16)
Bond Amount: (17)
. ■ OTHER FEES - .
Mitigation Fee: (18) (20) (22)
SBCC Surcharge: (19) (21) (23)
Total (Pages one&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) = (24)
Bulletin #100-January 3, 2001