05-103839 � �
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Federal Way r�
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P�RMIT Au� Q 2 2 �F Mk' CO ME EL PL DE EN FP
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� �FSOfiRAL WAY,�WA��98p6�•9�9�18 r�
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The ollowi Is re ufred in ormactton-an{nco lete a iication wiil not be acce ted. Piease rfnt i�e ibI in or
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' SITE ADDRESS �'.l��� 1.�� t �_ SUITE/i7NIT�
ASSESSOR'S TAX/PARCEL� _ _ _ _- _ _ _ LOT SIZE(s�
: LEGAL DFSCRIPTION(e.g.Acme Estafes,Lo
� (�uad+aeparc lorkngthykgu(a
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I TYPE OF PERMIT j2C$UILDING ❑ PLUDdBING ❑ MECHANICAI, '
i ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERIIYG ❑ FIRE PREVENTION SYSTEM
j PROJECT DESCRIPTION(Prouide detailed d�cription of work included on this vermit onlul
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A j � G L �J r�-,-��� 2 �� '3 c�,�,c�
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PROJECT NAME(Name of Business or Owner Last Name) 30U E, ��,,� -
• • • - •
PROPERTY NAME PRIMARY PHONE
OWNER MAIL�QADn�aF.ss! �'Go�J 'J (Ld� � �'j23 ' .�G.� �
[ GTY,STATE,Z[P
I EI Z� T�- •.i�'I c,. 19't) N�.L� � � .y
� CONTRACTOR COMPANY NAME `AP L[CAN1'NAME
OFFICE PHONE
� GK�' •�' C'on � � � s,..� �L°6 � �;L1 ' 6CS6
MAII.INQ ADDRESS CITY,STATE,ZIP CELL PHONE
f yZ� ���.�nu . ►.��.� �it� �•rru _uJ� 48Id`► (��� } � �� - ��Lv
QITY OF'FEDBRAL WAY BUS[NESS L[CENSE NUMBER EXPIRATION DATE - FAX NUMBER
l Z o -� �-1 c, 2 b �i $'B r, _ 1L� 3f � aS ��a6 ) 3t3 - �� 6
CONTRl�C7'OR5 RFqISTRATION NUMBER(copy o[c�rd reqnlred with each application� EXPIRAT[ON DATB
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� — � 9 � � �� � � Z� � v�
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I APPLICANT COMPANY NAME MPUCANT NAME OFFICE PHONE
� S ' ' n� � v n� . �?,�G )'S t'S - 6 6 �6
� MA[LIN(}ADDRESS CSTY,STATE,ZIP
�'�L� CELL.PHONE
'J'r 'S 9'tl� IIJu:G�J'ti1 %�J l�} `��Il (?o% ) ?7`+3 - 7 i11,a
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect o Tenant ❑Agent ❑ Other(DescribeJ �,z.��, � 5� _ 6,�6L
CONTACT NAM� PRIMARY PHONE E-MAILADDRESS
E D GH 2vc. 77� - 7�i 2+� 'e� C,�t.,, (�c.,r'i �s(vc
LENDER NAME
MAIL[NU ADDRESS (71Y�SfATE,ZIP
1 � : 1 � � � •
EXISTING USE PROPOSED USE B aSj G ��r.., .'�'
EXISTING ASSESSED/APPRAISED VALIIE S� VALUE OF PROPOSED WORK l� ��� ,J:� b
SPRINKLERED Bi7bDING? ❑yF.S c�NO FIRE SUPPRESSION SYSTEM PROPOSED/YtE(ZUIRED? ❑YES ❑ NO
WATER SERVICE PRUVIDEIt �AT{EHAVEN a HIGHI.INE p TACOMA p pg1VAfE(WELL)
SEWER SERVICE PROVIDER AI{EHAVEN � ffiGHLINE ❑PRNAT�(SEPTIC)
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AREA DESCRIPTION EXISTINQr PROPOSED TOTAL
. .FT. S .F'P. S .FT.
BASEMENT �
FIRST . '
1�i�1�'
SECOND ��i;
l�H `1
�r�-ccxn
FOURTH .
,
ADDITIONAL FIAORS(DESCI�jBE) .., r , ` �, _; `
t, . �'•• .
DECK(COVERE ?)�� � ' , f � � � � L ,
GARAG� �CARPORT❑ f c� S
b �
tusrura raorosso rorN. ; _�.. . . .........----..„�_ _.......;,i...��. ..
NUMBER OF FLOORS � � I
•*NEWHOMES ONLY'• NUMBER OF BEDROOMS_� ESTIMATED SELLING PRICE $ 3�v J�6
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Indicate number of each type of fixture to 6e installed or relocated as part of this project. Do n.ot include existing fixtures to rerreatn.
MECFIAHICAL
Value of Mechanical Work $
AIR HANDLINO UNITS EVAPORATIVE COOLERS ( dA3 L0C3S REFRI(}.SYSTEMS
BBQS �-I FANS HOOD3�co�,d,q WOODSTOVES {
BOILERS FIREPI.ACE INSE;R1'S F RANOES MISC(Describe)
� COMPRE3SORS i I�U12NACE3 �_ GAS WATEEt HEATEk3 �
DUCT3 _� QA3 PIPE OLTCLETS '
PLUMBING
3 BATHTUB3(or7Lb/sdoweccomho� � SHOWERS � WATER CfASETS([otkq MISC(Describe)
� DISHWASHERS �_ SINKS DRINKINd FOUNTAINS
GAS PIPE OUTLETS SUMPS L RAINWATER SYST
� WASHINd MACHINES URINALS HOSE BBBS
LAVS�e.tlwom sinka� VACUUM BREAKERS ELECTRIC WATER HEATERS
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I cert{fy under pertaity of perJr�ry that tha i�}(ormaHon furnlshed by me is tn�e and correct to tiee 6est ojmy knowLedge,and fwther,that I
am authortaed 6y the owner oj the abovs premtses to perJonn the work jor whtch ths perntit appftcallon ia mada I further acgree to hold
hcvmless the City oj Federal Way as to any ciatm(tncludtng costs, expenses, and attorneys'jeea tncurred in the trtvesHgaHon and dejense oJ
such claGr�,which may be made by any person,[ncluding the undersigned,artd jiled argairtst the Ctty oj Federa(Way,but only where such claim
arises out of the reltance of the ctty,inciuding{ts officers and empioyees,upon the accuracy oj the h{jormation suppiied to!he ctty as a part oj
this applicatton.
NAME/TITLE � DATE �/I/� S/
(Signaturc) [fide) —�
RELATIONSHIP TO PROJECT ❑ Owner ❑Agent ❑ Contractor ❑Architect ❑ Other
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Bulleun#100—January��20p5 Page 2 of 4 kU-Iandouts�Permit Application
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RESIDENTIAL-� COMMERCIAL
' NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRiAL SERVICE
�Single Family Square Feet 3`'�6 Seruice or Feeder Each Add'n
(First 1300 ft�-S 104.50;Each add'n 500 ft�-$33.50) ❑ 0 to 100 amp $113.50 $69.50
❑ Detached outbuilding or garage ❑ 101-200 amp 141.00 89.00
(Inspected with service) $44.00 ❑ 201-400 amp 264.50 104.00
❑ Detached outbuilding or garage ❑ 401-600 amp 308.00 123.50
(Inspected separately) $69.50 ❑ 601-800 amp 398.50 . 168.50
❑ 801- 100U amp 486.50 203.50
NEW MULTI-FAMII.Y(three units or more) ❑ Over 1000 amp 530.50 283.00
Seruice Feeder _
❑ Up to 200 amp $113.50 $33.50 ❑ Over 600 volts surcharge $89.00
❑ 201 -400 amp 141.00 69.50 ❑ Mast or meter repair $96.00
❑ 401 -600 amp 193:00 96.00 �TERED COMMERCIAL/INDUSTRIAL
❑ 601 -800 emp 247.00 132.00 �
❑ Over 800 amp 353.50 264.50 Seruice or Feeders
: ❑ 0 to 200 emp $113.50
ALTERED SINGLE/MUI.TI FAMILY ❑ 201-600 amp 264.50
❑ 601 - 1000 amp 398.50
Seruice or Feeder ❑ over 1000 amp 443.50
4 ❑ 0 to 200 emp $87.00
❑ 201 -600 amp 141.00 ❑ N of circuits to be added/altered
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❑ over 600 amp 212.50 (1-5 circuits-$89.00;Add'n circuite,�7.00/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
� (1-4 circuits-$69.50;Add'n circuits$7.00/ea) $89.00 plus 35%of Permit Fee
❑ Seivice- 1,000 amps or greater
❑ Mast or meter repair $52.00 ❑ Medical/Educational/Institutional Facility
MOBILE HOMES
❑ Service or feeder only $69.50
❑ Service aad feeder $113.50 .
I TEMPOFtARY SERVICE
i MOBII.E AOME/RV PARK Res{dentia�/MuIt1-Fam{Iy $61.00
❑ #of seivice or feeders
(First service/feedec-$69.50;each add'n-S45.00) Commerciaci/Industrial Service or Feeder Ampacciiy
❑ 0-100 amps _ $69.50
❑ I01-200 amps 89.00
❑ 201-400 amps 104.50
❑ 401-600 amps - 141.00
❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
❑ � #of Thermostats 0 M of Signs
(First-$52.00;add'h-$16.00/e� (First sign-$52.00;addh sign$24.50/ea)
❑ Low Voltage ❑ Swimmiag pool/hot tub................ $87.00
Square Feet to be served by system(s) ([ncludes additionat circuit,if required)
i�P'u�e Alarm System ❑ Yard Pole meter loops..................... $104.50
� Security Alarm System ❑ Additional Plan Review $104.50/hour
❑ Voice Cabling (for modif ed submittals)
❑ Dara Cabling ❑ Automation Fee oa all Permits .. $5.00
❑
• (Per Syste�n(s) 1•�2560 ft�-$61.00;
Each addh 2500 fc�-16.00) •Per WAC Z96-�69/0(5f(6/(&G)
Bulletin#100-January 7,2005 Page 3 of 4 k�HandoutslYennit Application
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Thfs is an overutew of possibie fees assoctated with the issuance of�rm{ts and is not intended to 6e{nclustve.
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PERMIT FEES �
Building,mechanical,and fire prevention system fee:>are based on the f�llowing schedule.
**Electrical and plumbing fees are calculated sepazately'k* . .
TOTAL PROJECT VALUATION [NCREMENTAL FEE FAC1'OR
(11 Sl.00 co�soo.00 (il;ai.00
(2J$501.00 to$2,000.00 (2��31.00 for the fust�500.00 plus$4.00 for each addiNona(ffi!00.00 or fraction thereot;to and
induding $2,000.00
(3)$2,001.00 to$25,000.00 (3)�91.00 for the first 7�2,000.00 plus$18.50 for each additional$1.000.00 or fraction thereot,to and
including$25,000.00
(4)�25,001.00 to$50,000.00 (4)�516.50 for the tizst 7�25,000.00 plus�I3.50 for each additiona!ffiI.000.00 or fraction thereof,W
and including$50,000.00
(S)$50,001.00 to�100,000.00 (5)fi854.00 tor the fint�50,000.00 plus.$9.00 for each addiNonal ffi1.000.00 or fraction thereof,to
and including$100,000.00
(6)$100,001.00 to$500,000.00 (6)�1,304.00 for the tirst�100,000.00 plus 57.50 for each additional�1.000.00 or fraction thereof,
W end lncluding$500,000.00
(�$500,001.00 to$1,000,000.00 (7)�4,304.00 for the rist i�500,000.00 plus E6.00 for each additional�I.000.00 or&action thereof,to
and including�1,000,000.00
(8)$1,000,001.OU and up (8)�7,304.00[or the tint 7�1,000,000.00 plus$5.00 for each addiNona!$1.000.00 or haction thereoC.
Table A �
PLAN REVIEW FEES
• Building Permit 65%of Building Permit Fees
• Mechanical Permit � 25°/a of Mechanical Permit Fees
• Plumbing Permit 65% of Plumbing Permit Fees
• Additional Building Division Review $63.50/hour
PLUMBING PERMIT FEES
• $26.50 Permit Fee plus $9.00 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) $3,011.50/single-family residence
' $950.50/multi-family unit
• Automation fee on all permits $5.00 .
• Demolition permit fees
• Required bond(s)/deposits
� Ify ouu need assistance completing the permit application form, or have questions
concerning the application process, please contact:
Community DeUelopment Customer Seruice Counter at (253) 835-2607
8:DO am to 5:DO pm, Monday through FYiday
Bulletm#100—January 7,2005 Page 4 of 4 k�I-Iandouts�Permit App(ication