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• •� •
, � AREA DES ON .EaQ3TII�T PROPO$ED Tp'Ppi,
' S :FT. S .FT. 8 .FT.
BASEMENT . �
' ' 1
FIRSf . ' �
i SECOND � • �
' 1T-IIRD � i
ADA�ONAL FLOOR3(DESCRIBE) �
; DECK(0 COVERED OR O UNCOVERED?) i
(3ARAQE � CAI2PORT O ' �
NUMBER OF FLOOR3 m�O n�oraes ror,�.. ror�sxn�awu ror,�cmwwsni� ror��s
••NEW HOIIlES ONLY''" . NUMBER OF BEDROOM3 F.3'1TMATED 3ELLINCi PRICE $
Indicate number of each type of fixture to 6e inslaUed or retocated as part of this project. Do not vu�ude existing fuaures to remuui,
MECNAMC�tlL
Vaiue of Mechanical Work$� (A G�OPY OF BID OR ESTIMATE MUS7•BE INCLUD,ED WITH APPLICdlTlplln
AIR HANDLINO UMT9 EVAPORAT!'VE COOLER3 OAS PIPE OUTLETS WOOD3TOVE3
BBQ3 FAN3 tiAB WATER HEATERS MiSC(Describe)
BOILER3 FIREPIACT INSEIi'f4 HOODS�eemmerei�q
COMPRESSOR3 . FURNACE9 gy�pEg
DUCT9 �A3 LO(3 SETS REFRIa.3YSTEM3�
PLil11�INCi' • �
HA1'fi7'IJBS�orTuu/sx�co� LAVS�s■u,ro,mswc.� URINAI.3 MI3C(Describe)
D13HWA3HERS RAINWA7'ER 3YSf VACUUM BREAKER3
DR1NHINd FOUNTAIN3 3HOWER3 WATER CLOSETS R.p.q
ELECTRIC WATER HEATERS SINKS WASHINO MACHiNE3 .
H09E BIBBS 3UMP3 �
� .
I cert(fg under p�nalty oj perJury that)am tlu propsrt�y own�r or authorls�d agent oj the property owner.I c�r#�y that to the best oj my
knoiottdge,tht iqfornutHon submitted iit support oJ thts psrntlt applicatton ta true and conetK.I cert(/}j that I w111 eomply with aIi appllcabie
Clty oJ 1►ederal.Wgy rsgutaHons pertalning to the work authorlssd by the fsauaute�oj a permi�.I undsratand that tht tssuancr oj thls permtt i
doei not remow t/u owner's rriponsibtlity jor cwmpl/ane�wlth[oca1,stats,or jederal iawa r�gulaHng consiructlon or environmental Iauu. �
I Jfurthsr agn�to ho/d harml�u the GYty oj lledsrai Way aa to any elaim(IncTadtng costs,expsnrea, and attornsya'je�s ineurred in ths �
inwsHgation and d4finse oJ aueh c/airr�, whleh rnay be made by any penon, 1neluding the underaigned, and Jiied agatnat ths city, but onlg
when sueh elaim arlses ou!oj Hu nHane�oj ths eily,ineluding fb o,ai loyeea,upon th�accurary oJ ths In�orniatton supplied to ,
the clty aa a par!ojthla application.
i
8YGNATURE: � DATE .� `��-5-�- �'� "
Pro Uwner and/ Autho Agent � �
' I
;
�
. 1
i
o NEW n ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUII.DIIQ(i BHELL ONLY? o YES.o NO BASIC PLAN? � o YE9 o NO ;
ZONINQ DEBIdNATION CHAH(iE OF U$E? o YE3 o NO .
NEW ADDRE$8 REQUIRED? o YE3 o NO � UP/SEPA/SUP o YES o NO �
PLATTED L0�1'? 0 7PE8 o NO DEMO PERMIT REQUIRED� o YE3 a RO� '
4 •
�
I
I
� �
` Bulletin�!]00=August 16,2007 Page 2 qf 4 . �k�Handouts�Permit Application
i �
• y � � � i �.l-.,,:..I.WIt�.,�-1-�i� �.�11 ��� � �il��i��i1L. �{.�1 I�I:��i�)�.
� ���r'���� '��'�
cIr r oF �. `� ^ � b
.� �E�I"1` f � 6tmi►IItiCDMbIdN
�, , 33530 First Way South
yv ��Y ���'� � , '`_, � Fcderol Wny,WA 98003
(253)661--0000
�+�1 �`vr Fax(253)661-4129
�l9��..�f '��v�.c�7��'�Y
FIRE R�O'1'ECTIQN �YSTEM APPLICATION
Federal Wey Business l.,icense n�umber:
F P S_O l . O'2. 770 —oo—�
PARC�1.�
Commereiel ❑ Residendel O
SITE�OCATIQl11�B;� .
(�'"„
Z�ennnt/Ownor �C'���`_ ���_ - Fhnne
=�� ���� �, �L � �
Addtess/CitylStxtd7.ip `-- (� � < f--� � � t�
�, .�"
r�aw�or wor r� � l,l.. �r�`�� . )�) l�l�-�(,�(' f� Ptojeat Valuation:�_b��%
� �_.__ ��u''i�t�i�--��
� ��s;�,vc. �o �5�, .
APPUCANT
tlerne � � � .(� � d �_�-{�- ` � �� � �
Addreea/City/St/2ip �r.1 ����- ��(� � U-�C� - l�)��
Contact person��., � -� pbo��ne 7 � � _1.��� ��' ...1��`7 , '�(�'C>�
CONTRACTDR
n `g
Compeny Name- l�/A ,
Address/City/SVLip
Contaat Pe�son Phoae
F�K
Stste L�I Contrec6ar Regis�ation# �����,����j (�L� l�.-C:1 - �
�'me.n.�,e es p.�.e,�r�,� r-----_•..-- �xp.Date C� �
�'L�ASE SUBMIT THREE(3)S�'[S O�'DRA,Wirres A�Nv cur�H�ETg,�E�t I�IFyA 8i'ANDARD3,
MAXIMUM pLAN SHkE'�'SIZE: 24" x 36"
aacUlrMell r cnary.vnMr pw�ry eep�dury.u,d me hMlN�,,,
f0l vhiah pexrt�R� 9nN �he�IYn.b eu.�nd eetf�t b�ha bqt ol my bwrvlelee v�Ml�v�tut 1 MII f90wr�ned Dy tl�e w�ttM eC J�e eAovs P�r�111d b pefeim Ih�vMk
pP on k m�de.l Cm�M7e�a��s twnleat ihe Cky of PeOetL'Nry es�o my eY�en(moludy cau,
IIq1alry�ny pn,e0f�In �he oldeis�ed�nd d.d�iA�Gy etF eV. 'aP���nd�rtoewf+'��n�tuted'm maeseea4on u�d lalbn+a o[�ucA e111tiU,�dieh m�y be
�pm�don�uppfiedC�dia n a�i pan d 4�6�ppYe�d011. ��� P lut on1�.Me nte�a41m�dm oul of Ib0 retiu�te ef Ne db.isduby ib nmcees a.d�mpteyvp,uPe�M ucraay of N<
n C�
Owncr/Agent �'�� 7-�Z �-C�
ms.n,.
— . Datr,
Mnrm!/�ur�
`
� ���' R CEIVED CONSTF TION PERMIT App�Cq-�-IOn
� • V�1 (-�y �� PPLICATION NUM6ER: � - �_ -
• ` ' _ - - -
�' PPLICATION NUMBER: _ -
� � L O 3 ZOOZ pp(,I�nON NUMBER: -
i _ — —
� **The followinyJ�`�tk�(g¢rg+q�E���at;n�Y please print(in ink)or type**
Please note: Electrical,Fire Prevention�Iys�ei�t��d��igineering permitr may require a separate appli�ban.
. � . � . •
SITE ADDRESS: �j`l Si7 p�'L t�1 C �/� s • .
ASSESSOR'S TAX/PARCEL#: _
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
' • • • •
TYPE OF PROJECT(This application): J UILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
^ • ❑ ELECTRICAL ❑ ENGIIVEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): ��..•�'�4"r�c C�V� �7C �S^r��}�Z
�1vVt�L"7LJ 7 �� C'7f�/
PROJECTNAME: _ � �'" - � �`�''2 I/`�T-J �
• • • • •
PROPERTY OWNER: NAME:
L,S7 � ;, A� j' /J� JJ ;�, ,�C 1�I DAYTIME PHONE:
L�_., �vCS�� �-T,l�- V\/� �"� �G.�� ��L�1 'O 1 �
MAILING ADDRESS(SiREET qpORE55;QTY,STA7E,ZIP):
S�Ar� �-� S
CONTRAGTOR: nar�e:
T`�� � DAYTIME PHONE:
" �'b )ZZ-3 - � I
MAILING ADORE55(STREET ADDRE55;QIY,STATE,ZIP): EVENING PHONE:
P-�- �a�� 3 � s 1� � 8 �� � �
CTfY OF FEDERAL WAY BUSINESS LICENSE NUMBE� - o� � � ' � - ��'� FAX NUMBER: J
� _ _ � )Z� _���-�j
CONTF2ACTOR'S REGLSZRq7[ON NUMBER: EJ�IRATION DATE:
'� c1 �3 � � D :L t � ,� /J � �4 %3� l C��
APPLICANT: NAME: - - - -
DAYTIME PHONE:
MAILING ADDRESS(S7REET'ppDRE55;QTY,ST'ATE,ZIP): EYENING�qNE:
RELATIONSHIP TO PROJECT: � � �
FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): � � _
E-MAIL ADDRFSS:
CONTACT PERSON FOR THIS PRO]ECT: ❑ PROPERTY OWNER ❑APPLICANT CONTRACTOR
� . : . ,
� EXISTING USE: . EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUTLDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIOER: ❑ t11KEHAVEN ❑ HIGF1LiNE ❑ TACOMA ❑ PRNATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRNATE(SEPTIC)
�
, . . 1
. ',�
� s .
ssp(EW RESIOEN7IAL CONSTRUCTION ON
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: � � I
• . . . -
i
�
FLOOR EXISTING .FT. PROPOSED .FT. TOTAL �
BASEMENT
FIRST
SECOND
THIRO
FOURTH
OTHER FLOORS(DESCRIBE)
.DEC}C �
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate numbe�of each type of fixture
MECHAIVICAL
AIR HANDLING UNIT(S) EVAPORATNE 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) FURIVACE(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
DUGT(S) G/1S PIPE OUTLET(S)
PLUMBING
BATHTUB(S). LAVATORY(S) URIIVAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINIQNG FOUNTAIN(S) SHOWER(S) WASH MACNINE OUTLET
GAS PIPE OUT'LET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
. •
i certify under penalty of perjury that the i�formation fumished by me is trve a�d correct to tfie best of my knowledge,and
furtfier,that I am authorized by the owner of tfie above premises to perfonn tt�e work for which tfie permit application is made. I
fuNfier ag�ee to hold haRnless the Gty of Federal Way as to any daim(indudi�g costs,expeoses,and attomeys'fees i�cumed ia the
iavestigatio�and defense of such deim),which may be made by a�y person,induding the undersigned,a�d filed agai�st the ,C'.�ty of
Federat Way,but o�ly where such daim arises out of the relia� e dty,i�duding its officers and employees,upon tfie accuracy
of tf�e infortnation supplied to the dty as a part of this appli n. •
NAME/T1TLE:
l�l/�-`V DATE: � ' �� �
❑ PROPERTY OWNEft ❑ APPLICANT ONTRA R
__._..... _...... .
#OR�FFiCE USE ONLY
. . . .:::. ._ . .. ._ � {i. Y '_.: � '
"�"1VEW..3--�._,;'��ADDITION=. �.ALTERATION �'��itEPAIR . .;::��'£NAN�'�iMPROVEMENT�_� ;
,: >
CENSUS CODE: v. ..__..,.._._,. <: .----�.�LOT�£ _ _.__ ._: - '- _:
---.., ----- ----- > ,._ _
_� .—.__ __.
I:ZONING OESIGNATION.---;_ -_ - : ��._:rBUIL'DING SHELL-ONLI(Y C�TYFS__�-;� NO.:=....
_COMP_pL�1N.DESIGNATiON ' - � '�BASYC;PI�1N? :__ .� YES -��VO ..��... -- ---- -
>- - ,
_ — __ _
_ ;::: _ ,: :
- .._
`�ECTION _� .;. TOWNSHIP, . ... RANGE _ _ . ,: ;NEW�ADDRESS RE UIRED� :: ,I� YES ;_ ❑ NO ;
_ _ _ ,
PLATTED L077 �YES -D-iV0.' `, ;::CHANGE OF USE? ':: ❑;Y£S -� NO; _ :;
QOMMUNCiY OEVELOPM�`I'f SERVICES•33530 FIRST WAY SOUTIi•P.O.BOX 9718•F�ERAL WAY,WA 98063-9718•253�61�000•FAX:253�i61-4129
�
Cor�uction Permit Fee Calculatior�ieet
*******PLEASE NOTE: ALL FEES MUST BE YERIFIED BY CITY STAFF PRIORTO ACCEPTANCE OF PAYMENT.
� CHECKS FOR INCORRECT AMOUNTS.WILL NOT BE ACCEPTED!*******
Building,mechanipl,and fire prevention system fees are based on tfie followi�g schedule.
TABLE A
TOT/LL VILLUATION FEE FACTOR
(i)Si.oa m#soo.00 (i>izsso
(2)SS01.00 to;2,000.00 (2);2350 for the first j500.00 plus�3.OSforradr add'�tia�a/SSOO.00or frac.�oa thereof,bo a�d IndudirxJ#2.000.00
C.i)�2.001.00 to$25,000.00 (3);69Z5 for tfie first;2,600.00 plus$14.A7 hxraoh�tiara/SI.A70.00or fractio�thereof,W and Induding
;25,000.00
(4);25,001.00 to;50,000.00 (4);39L25 for the first 5�5,000.00 plus$IO.10l6rradr�da�w/SI,IXIO.AOor(ractio�C�ereof,to a�d kxluding
Sso,o00.00.
(s�#sa,00i.oa roo#ioo,00a.00 (�S643J5 for the first 550,000.00 plus$7.00 hxPad��Giata/S1.00O.UOor fraction tliereof,to a�a k,dua��y
;ioo,000.00.
. (e�;ioo,00i.oa oo;soo,000.oa (�S993J5 forthe first;100,000.00 plus#5.60 hxe�dr ad�'�dbna/SI.OAO.00or fraction tl�ereof,to aad Induding
jsao,000.00
m ssoo,00�.00�;�,000,000.00 m;3,�3.�5���;500,000.0o a,�;4���,�,�st.�.�oa�«,�,ro a„a�,���
;i,000.000.00.
(8)51,000,001.00 and uP (8)55,608J5 for tlx first#1,000,000.00 plus#3.65�6r rad�aafdibiona/SI.000.00 ar fiactlon tt�eof.
BoW aum6er is tfic base fee for fhe spedfiad i�w�ema�t
t�a�idred.und�ned number h the fee oer addJdana/sncdfied Inaremrrt
PLUS: Add 65 percent of tfie base building pemiit fee for plan review fee.
Add 25 percent of ti�e base mecfianiql permit fee fo�mechanipl plan review fee.
Add 15 percent of the base building pertnit fee for Fire District#39 surdiarge,commerdal only.
Add$4.50 for WA State Building Code Coundl,plus$2.00 per unit for duplex&above.
** Electricai,plumbing,and mechanical fees are calculated separdtely**
.
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 Fre Department Surcharge: (3)
(COMMERQAL ONII�
PROPOSED VALUATION:
FEE FACTOR FROM TABLF A: Number: (a)Base F�e:
(b)Additional I�aement Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (S)
•
PROPOSED VALUATION: �
FEE FACTOR FROM TABLE A:Number. (a)Base Fee:
• • (b)Additio�at Inaement Fee:
Estimated Permit Fee: '(6)
Estimated Plan Review.Fee:,(7)
BaSe Fee Number d Fadxes
$21.00+{ X$7.00/fixtu�e}_ (8)Estimated Permit Fee
Esa�Pamit Fee
� X .65= (9) Estimated Plan Review Fee
Misoellaneous Fxtuce Charge:(10)
Sub Total �P�a,�>: Line(s)(1)+(2)+(3)+(4)+(5)+{6)+(7)+(8)+(9)+(10)_ (il)
TABLE B
NEW RESIDENTiAI SERVICES MOBILE HOMES � • M(SC EQUIPMENT/TEMP SERVICES ,
_Singlc Famii= _Service or feeder on(y.........................544.25 _#of Thermostats(First-S33.SU;add'n-S!O.SOea)
(Frst 1300 ft-E67.00;Each add'n 500 ft'-$21.50) _Service and feeder...............................572.25 _#of Low voltage fire or �a(arms
Square FeeC First 2500 = . ; ch addn 25 =-S 10.50
_Each outbuildingor garage...........................528.00 MOBILE HOME/RV PARK S eet:
([nspected with secvice) _#of service or fecders ' 4 Per WAC 296-46-910(5)(b)(i&i'
_Each outbmlding or gacage...........................544.25 (First servicdfeeder-$44.25;Add'n s ' _#of Signs(First sign-$33.5a;add'n �gn
([nspecied separately)
feeder-$28 each) 516.00 each)
� _Progress inspectio r...............$33.50
� ' oo,hot tub,spa.................67.00
_Yard Pole meter loops...........................44.25
NEW MULTI-FAMILY COMMERCIAL/INOUSTRIAL COMMERCIAL/INDUSTRIAL
(Includes thrce units or more) Altered Service or Feeders
Secvice Feeder Amps Service or Add'n _0 to 200...............................................$72.25
_Up to 200 amp.........._...$72.25.................$21.50 Feeder _201-6Q0..............................................169.00
_201-400 amp..._.:...._......89.75....................44.25 _0 to 100..........................$72.25........S 44.25 _601-1000........................................_...254.50
_40l-600 amp..........._....123.25........••••......_.61.50 _I O I-200..........................89.75...........56.25 _over 1000.............................................282.75
_60l-800 amp.........._....(58.00....................84.25 _20!-400........................ 169.00......._...67.00 #of circuits
_Over 800 amp...........__....225.25..................169.00 _401-600........................ 197.00...........78.75 (I-5 circuiu-$56.25;Add'n circuits,$5 ea) .
ALTERED SINGLE/MULTI FAMILY _601-500........................254.50.........10725
(When inspected separately from the services.) _801-t 000......................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 surchuge........•••...........56.25 _61-100...•••.....................................•••....44.25
_201-6U0 amp................................................89.75 _Mast or meter repair..............................61.50 _101-200................................................56.25
_over 600 amp................................................ 135.25 _201-400.._.............................................67.00
_Mast or meter repair.......................................33.50 _401-600.........................._.....................89.75
#of circuits _over 600.................................................97.75
(1�circuits-$44.25;Add'n circuits$S ea)
!f se�vice is great�r thaa 200 amp,a plan review is req'd.Fee is 3S°/a of permit fee+$j6.25.Add'1 plan review for other submissio�s is$67.00/hr.
_
'� �#iXTURE-DESGRIP?ION A';: . .FIXTURE:FEE FROM TABIE B B .; iVUMBER;OF UNITS C :: -
;:
__: _...,--TOTAL D _ �_.:_.
TQTAL GOLUMN;�:D =
Total Colum�(0)
Estimated Permit Fee: (12)
Estimated Permit Fee from Nne 12
Estimated Plan Review Fee: $56.25+ X.35= (13)
. • •
Estimated Permit Fee: (14)
Bond Amoun�(15)
Estimated Permit Fee: (16)
Bond Amouar (17)
.
Mitigation Fee: (18) �2p� �Z2�
SSCC Surcharge:(19) (21) (23)
TOtal �Pa�esone&rWo>: Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) _ (24)
Bulletin #100—August Z9,2000