06-101727 REC!VED •
CIT'OF,..,..-
PERMIT
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Federal Way APR o s ?o' PERMIT 9(1 ,4. `�
33 25 AVENUE SOUTH oMMUNI2Y DEVELOPMENT s BOX RVICFs`i1TY0F FE^ Com' MF CO ME EL PL DE EN FP
FEDERAL 07Y,FAX
98063-9718 gUILDIN I CATI O N TD / 2 04
253ww r.It o FAX hong.,,.,m 9 �. /
The following is required information-an incomplete application will not be accepted. ease print legibly in ink)or type.
"` syy `" IN -PROPERTY INFORMATION
SITE ADDRESS c e)C3L J 3YeZ ae/‹... 56,,c/ SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# I i I Co C) 0 - U G '-4 ,5 LOT SIZE(sf) ❑i '-
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 1.---`-'.7- 1 X Cv 3 .c'C I S ��l•- :r1 t v
NI
(Attach separate page far lengthy legal description)
t R , st •r 1'. `"' Z ..:4:0%.V;-(4::".:::::.:;,:-,Z, :,Mk r 2r i $:sr c.;,IN PROJECT INFORMATION. •
TYPE OF PERMIT a BUILDING ❑ PLUMBING 0 MECHANICAL
'$ DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
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W If./1,44.Lf�M C/
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I. , . rPROJECT NAME Name o Business '" ' •( f or ner ast Name) "'�•T" - _ _ - - `
.. .... . . ; ,,,::,U PEOPLE'INFORMATION ••,
PROPERTY NAME
PRIMARY PHONE
OWNER C�L-"A-r 1---t.),-5 p /A--I t C.e__ ..,.,"1-;€..., (i-75I) 3.s-1 '5 z.0
MAILING ADDRESS CITY,STATE,ZIP
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CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
l��l C vy`?vyv, Cc.,--:S i 1...-4--4.- i� 'T•- s! 4:.7 pm v.-I...- (2 L) c''1 ) - `--1 I 1 j
MAILING ADDRESS CITY,STATE,ZIP t
=C. I I q 5L a�� v CELL PHONE
CITY OF FEDERAL WAYDBUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
c- / - --G 'Tj e_ -B L ' / / ('-t .) L Z - 9 x1:5
I / CONTRACTOR'S EGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
1pA 1C a_
_ Z— i F Lr ) / :t.. i / CJ
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
'V-4 r+off.--TC C.-L."-A---1-•r-c.v.., .'F'.�'i_d_. (>-3) "l .Z.-fir
MAILING ADDRESS ,-) CITY,STATE,ZIP CELL"DONE
Z 2.- S i- &c .r ,.c t:, .--` 9 3t:`,:i (._
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RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent 0 Other(Describe) v ✓'' C-I:. ( ,
' l
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
tr..)/a T ,11.*._ r.•.A ic-r=_ (.10C.) .3 91 - I 1 1 rr+i.1,A 2�.- N,- v •I.u— •C---W
LENDER vS
f' rk a a'+, (0 t4 • + 1';y NAME
rvitw
MAILING ADDRESS CITY,STATE,ZIP PHONE
AY pp ( )
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l��'Y....he f2 i r y!f j}1 t}crit fit<�Irl '��4 A�rk'N, Y.1i ¢}j�v1'Ic� ?:F;)da ;�µ3
e..•. n k 1 :,, ,�,,.. ..a,t.... >t,t, DETAILED BUILDING'INFORMATION t ' _ b I M1 7 I tc
... +�',.� xs�' 51,;`v st Ali,��Y.{y'�tr�>��-'?ii..r ii4h�'4 3�,71�E t�r��'L FnxS re --��
., .... .. ..er. ..V, ..� Y.a{-,
EXISTING USE G PROPOSED USE .S G‹.
EXISTING ASSESSED/APPRAISED VALUE $ '-f c>CD.1 C. c. VALUE OF PROPOSED WORK $ -Pi 000
SPRINKLERED BUILDING? 0 YES 4i(NO FIRE SUPPRESSION SYSTEM PROPOSED%REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PRnVTT)F"R lad T.ATIFT.AT7Frr rn vrnrrr,m, - _- "-_____.
S •
•. ...r, .. .. s f.• -y•
SPROJEC,
T FLOOR AREAS •
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AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT i � )
FIRST i CI Z 1'Z.,_.
SECOND
THIRD-
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE IA CARPORT❑ Za
=stum PROPOSED TOTAL. , y { aa.a ' r � � r a g Br T, 'r
NUMBER OF FLOORS '1J,1 ti��s t hr . ,12.4; #, � � `s�k Its �
ix•a ,.�.�ti,;e�„�,�ma..i .,,::,�6.. ,�.eL„.,.,x..3 s�to-:�-t s7r.3.�an�r
"NEW HOMES ONLY* NUMBER OF BEDROOMS Cv 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.
M 'JFJANIC.AL
Value ofchanicikyLork $ 41°Q -
AIR HANDLING UINI a . EVAPORATIVE COOLERS REFRIG.SYSTEMS
BBQS �_FANS HOODS(commercial) WOODSTOVES
BOILERS _FIREPLACE INSERTS _ RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS c, __ _ GAS PIPE OUTLETS
PI rrt;rr37NG
- it _ BATHTUBS orTub/Shower Combo) SHOWERS J� WATER CLOSET t,_u.q _ MISC(Describe)
_ _ DISHWASHERS SINKS DRINKING FOUNTAINS
_ GAS PIPE OUTLETS SUMPS ti 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 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` DATE " • • CO
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner Agent 0 Contractor 0 Architect G Other _
Y p + g < Dr t tit,
;La401� .. 1r ti 1 t(",��+I� {.4)1F ::W:13"14• E� Ytt .�� :P7�p/��1�.) ®�- kG•"�E;.�' t rd t`#aitsS�I�t �.i .y,m Ir trl
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441MAlig : n „ ' ,„1r . , ..011, $ *� N""J S.(-iut
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h., ?-1'...''''''''' .' ELECTRICAL•PERMIT'INFORMATION !:!'`
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
❑ Single Family Square Feet Service or Feeder Each Add'n
(First 1300 ft2-$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 ❑ Over 600 volts surcharge $91.50
❑ 201 -400 amp 145.00 71.50 Cl 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 CI 201 -600 amp 272.00
❑ 601 - 1000 amp 410.00
Service or Feeder
C,10 to 200 amp $89.50 CI over 1000 amp 456.50
43/201 -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)
Ed
4 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 X
❑ #of service or feeders
(First service/feeder-$71.50;each add'n-$46.50) Commercial/Industrial Service or Feeder Ampacity
Cl 0-100 amps $71.50
U 101-200 amps 91.50
❑ 201-400 amps 107.50
CI 401-600 amps 145.00
❑ over 600 amps 157.00
MISCELLANEOUS SERVICE/EQUIPMENT
® 04- #of Thermostats ❑ #of Signs
(First-$53.50;add ti-$16.50/ea) (First sign-$53.50;add'n sign$25.00/ea)
❑ Low Voltage ❑ Swimming pool/hot tub $107.50
Square Feet to be served by system(s) 4," (Includes additional circuit,if required)
El Fire Alarm System ❑ Yard Pole meter loops $71.50
B Security Alarm System ❑ Additional Plan Review $107.50/hour
® Voice Cabling (for modified submittals)
151 Data Cabling
❑ Automation Fee on all Permits .. $5.00
(Per Systeni(s) 1•t 2500 ft2-$63.00;
Each add'n 2500 ft2-16.50) `Per WAC 296-96-910(S)(b)(i&if)
111101b° •
:; 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
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Bulletin#100—January 1.2006 Noe 4 nf4