04-104137 ` ,�Iv�� CONSTRUCI J PERMIT APPLICATION
UTY OF � ��� �
PPLICATION NUMBER: j' - - �
Federal Way PPLICATION NUMBER: _ - -
OCT 1 12004 - - - - - - _ _ _
PPLICATION NUMBER: - -
`*The�bj�p�yt{(��i��ii`,�¢i�f�rmation—Please print(i�ink)or type*'
DUI la UCI"I
Please note: Electrical, Fire Prevention Systems and Engineering pe�mits may require a separate application.
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SITE ADDRESS: ASSESSOR'S TAX/PARCEL #: � ��.,Z �Y� - � ���
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
. • • • •
TYPE OF PROJECT(This application): ❑ BUILDING o PLUMBIfdG ❑ MECHANICAL o DEMOLITION
o EIECTRICAL o ENGINEERING�FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): 5� r � M �� r' ' D�,S IQ IlJ �1 N� �N Sr*� 1
c7ti/��' E-i�,Aro �', � r� r� ,.� �,.1s- �-S �ti n�Ct.cJ �+ti1-o Za.vG /3//.�G�
PRO]ECT NAME: _ A[1r�Z,O JV� S Ta r�,� ��j��
• • • • •
PitOPERTY OWNER: N^ME: ; DAY?IME�HONE:
S�+G.� � 'l`�'1�1 ) - �
� MAIUN ADDRESS(STREEf ADDRESS;CITY,S7ATE,ZIP):
; �1z3_ S. F�ow�T 5•r��T v�,_.�.N�.,�r►�s -r��.0 381�3 �
CONTRACTOR: NaME: , � DAYTIME PHONe: ,
; ��fiT'2.10�' -�i'z�. P�oTE.GT'� o�J ! c�s3 ) �-ga -34Z 1 ;
i MAIIING ADDRESS(SiREET ADORESS;C1TY,SiATE. IP): I. EVENING PHONE �
L�� a`7 ��"�`� ,A�/c-.. G+►s �' T�/�, 1,v,p98 3r.o ; (.0 3 >9 Zb -L Z� o i
CTTY OF FEDERAL WAY INE55 LICENSE NUMBER: , FAX NUMBER: 7
1 � - � � t o t�S 8 a a_B� 1 c ) - �
CONTRACTOR'S REGISTRATION NUMBER:
� IXPIRATION DATE:
c���.����> T� 1�� � � o t o5 � L�oli
APPLICANT: NAME: DAYTIME PHONE:
� C����. 1Zoasi►�s�n) � (z63 )zg� - -3�21 �
MAIL[NG AODRESS( EEf ADORE55;CITY,STATE,ZIP): � EVENING PHONE:
j 27 0� ?oT+ti P.�E �is-t fi,�►u�n,� ,,.v�A CL`$3 6� ; ( ; _ l
RElAT70N5NIV TO PRO7ECT:
� i FAX NUMB:R: ;
( ❑ ARCHITECT ❑TENANT �THER(DESCRIBE):,��5�/J�.� . � � - �
�
j E-MAIL ADDRE55: I
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CONTACT PERSON FOR TNIS PROJECT: ❑ PROPERTY OWNER �APPLICANT �ONTRACTOR �
� � : � • • •
EXISTING USE: EXISTING BUILDING ASSESSEO/APPRAISED VAIUATION ;
PROPOSED USE: PROPOSED VAtUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? �YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES o NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN �HIGHLINE o TACOMA r� PRIVATE(WELL)
SEWER SERVICE PROVIDER: O LAKEHAVEN O HIGHLINE O PRIVATE(SEPTIC)
#*NEW RESIDENTIAL CONSTRUGTION ON'Y**
NUMBER OF BEOROOMS: ESTIMATED SELLING PRICE: �
• • • • •
FLOOR EXISTING S .FT. PROPOSED S .FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD �
FOURTH �
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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(5) FIREPLACE INSERT(S) RANGE(5) MISC.( )
COMPRESSOR(S) PURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑GAS
PLUNiBY(dG
BATHTUB(S) LAVATORY(S) URINAI(S) WATER HEATER(S)
DISHWASHER{S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC o GAS
DRINiQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(5) SUMP(S)
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I certify under pe�atty of perjury that the Information furnished by me is true and correct to the best of my knowledge,and
fucther,that I am authorized by tfie owner of the above premises to perform the work for which the permit application is made. I
furthe�agree to hold harmless the City of Federal Way as to any ciaim(including costs,expe�ses,and attorneys'fees incuRed in the
i�vestigation and defense of such ciaim),which may be made by any person,i�duding the undersigned,a�d filed against the City of
Federal Way,but only where such daim arises out of the reliance of the dty,induding its officers and employees,upon the accuracy
of the inforniation supplied the dty as a rt of this application.
NAME/TITLE: DATE: /Q—�� —d�7
❑ PROPERTY OWNER o APPLICANT �CONTRACTOR
r F,OR•OF�ICE.USE;ONLY:;�
��:. � .. � - ,�.,„... � ,�..� a_n.,�� � ��, �.•�.. .�..., ..�. ��
,: � _��:�� .,.�..,�. .-
't7;:NEW,,`�;����ADDII"IUN���[7�ALTERATIO.N��n.REPAIR�°�"�„��,:TENANT IMPROVEMENT�-�_�,;�
:'.CENSUS:CODE-�����;;'�.�-����`�' -��,•�"�:�;;aLOTSIZE::�������°��'���a�;����: >� `;-�.
'ZONINGTDESIGNATION;�,�,����;����������.�BUILDING SHELL'�ONLY7�a;YES:;��:o NO '�
uCOMP PL'71N D'ESIGNA7'ION u �� ,��'���,'.�', �BASIC PI.AN?��YES ,'"� d,NO�r"'� z '� -
=SECTION`�� �,=TOWNSHIP �� 'RANGE �'?��, .NEW ADUFtESS RE UIRED? , �:� :o'YES ;.a NO �„ i
PLATTEO:LOT? ''i❑YES:'=��NO ,����"�:��,�:��{�. ,CfiANGE UF USE7;- ;,., =d YES��=o'NO �`
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661�000•FAX:253�i61�129
www.citvdFede2lway.com
Con�ction Permit Fe� �eet
*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY G.. PRIORTO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WILL,'': ;c ACCEPTED!*******
euilding,mechanical,and fire prevention system fees a�e �fd on the foliowing schedule.
TABLE A
TOTAL VALUATION FEE FACTOR
(1)Si.00 co Ssoo.00 (i)Sso.00
(z)5501.00 to s2,000.00 (2);30.OU tor the first;500.00 plus S9.00fo�each additiona1S1A0.P0or fraction thereof,to and induding
5�,�.00
(3)SZ,001.00 to SZ5,000.00
(3)s90.00 for the first;2,000.00 plus,�18.OYJ fvr each adCitional SI.ODO.OiO or fraction thereof,to and
induding 525,000.00
(4)s25,001.00 to;50,000.00
(4);504.00(or the Tirst f 25,000.00 plus SI3.00 for each additiona/SI.AOOGt�or fraction thereof,to and
Induding$50,000.00
(5)$50,001.00 to#100,000.00
(S);829.00 for ifie frst=50,000.00 plus S9.A�for each additana/SI PA�IXI or fraction tfiereof,to and
induding;100,000.00
(6)5100,001.00 to$500,000.00
(6)51,279.00 fo�the fttst j100,000.00 p�us S_7,Q7 fo�ead�addi[iona/SI L170 OYI or fiactio�thereof,to a�d
�duding 5500,000.00
(�5�,�1.00 to=1,000,000.00
(��4.079.00 for tfie fist 5500,000.00 plus S6.A�far each addit%�na/SI Li�O A7 or fraction thereo(,to ar�d
Induding j1,000,000.00
(6)51,000,001.00 a�d up
(8)57,079.00 for the first;1,000,000.00 plus 59.50 for each addibbn�l S7 Lb0 A�or fraction thereof.
Bold number ts the base fee for the spedfled Increment
!�a//p�zed onde�lned number/s the fee aer aAd/Hona/soedfied Inarment
PWS: Add 65 percent of the base bullding pertnit fee for plan revlew fee.
Add 25 percent of the base mechanlcal permit fee for mecha�kal plan review fee. -
Add 15 percent of the base bulidi�g permit fee for Flre Distrid#39 surcharge,commercial only.
, AdC$4.50 for WA State Building Code Coundl,plus$2.00 per unit for duplex&above.
*•ElecUical,plumbing,and medianical fees are cakulated separately t*
PROPOSED VALUATION: ,
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (1)
Estimated Pla�Review Fee: (2)
Estimated FW Fre Department Surcharge: (3)
(OOMMERCIAL ONLI�
PROPOSED VAIUATION:
FEE FACTOR FROM TABLE A:Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
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PROPOSED VALUA � .� , 3 �L-�� �� _
� � �_�
FEE FACTOR FROM mber: (a)Base Fee:
(b)Additional Increment Fee: Z l (� • ��>
Estimated Permit Fee: (6) � d�° ��'
Estimated Plan Review Fee: (7) (�`� .� C
Base Fee Number of Poctures
$26.00+{ X$9.00/fixture}_ (8)Estimated Permit Fee
Estimated PermR Fee
X .65= (9)Estimated Plan Review Fee
Miscellaneous Fxture Charge:(10)
Sub TOtal �Pa�or,e>: Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10)_ (il)
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
Single Family _Service or fceder only_.._._.................$57.00 _a of Thermostats(first-$43.00;add'n-$13.00ca)
(Pirst t 3U0 ft�-SR�.50;Gach add'n 500 ft'-$27.5pj _Scrvicc and(ccdcr...............................$93.00 N of Low voltage firc or burglar alarms
iquare Fcet: _ firs�2500 11'-$50.00:Each add'n 2500 ft`-�13(i(;
Gach outbuiidin�or ara c................._....... �3�.50 S uare Fcct:
c g € MOBILE HOME/RV PARK 9
Qnspcctcd��•ith scrvicc) #of service or feeders `Pcr WAC 296-46-910(5)(b)(i R ii)
Each outbuilding or garaoc....................._....557.00 (first service/Ceeder-�57.00;Add'n servicc/ _�of Signs(First sign-543.00;add'n sign
(Inspected separately) feeder-$37 each) $20AU each)
I _Swimming pool,hot tub,spa...............$85.SU
� Xard Polc metcr loops....._..._.._... .....�S7A(� �
i
� NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAI COMMERCIA!/INDUSTRIAL :
� (Indudts Ihrce units or morcl Altcred Service or Fecders �
� Scrvice fcedc� nmps �er��c�or Add'r� _0 to 200......._......................._._......-i 9;.:1U i
Up�0 2(N1 amp._....__. 5 93.OG...._..._.....� 27.50 Feeder _201 -600........._........................__..__.ZI�.SG ;
_201 -a00 amn__._...._ 1 IS.SU............._....57.00 0 ro 100.........................� 93.OG...._.g 57A0 _ti0M -1000..._..._................_............._326.SG i
` y01 -600 amp................158.50....................78.50 _101 -20U........................ (15.50...........72.50 _over 1000.............................................363.Ofi
I501-800 amp................202.50.................. 10&.50 _201 -a00........................216.50...........85.50 k ot circuits I
Ovcr 80U amp.. ..........._.2R9.50................ 216.50 _4U1 -600................._.... 252.50......... lO1.OG i I-5 circuits-$72.50:Add'n circuits,�6 eai
ALTEREO SINGIE/MUITI FAMILY _601 -$00........................326.SG.........138.00 -
(When inspected separately from the services.) _801-1000......................399.OG.........166.50 TEMPORARY SERViCE
Scrvice or Feeder _Over 1000......................434.50.........232.00 Residential/Multi-Family/Commerciai/Industrial
0[0 200 amp...............................................$ 71.SQ _Over 600 volts surcharge......................72.SG _U-I00................................................g 57.00 �
20f -60U amp.............................................. I I5.50 _Mas[or meter repair..............................78.50 _101 -200...............................................72.SC
over60U amp.............._...._....._.................... 174.U0 _201-400.._..............................._...........8�.50
Mast or meter repair_.....................................43.00 40I -600........._..._.................._..........t I S.SU �
� �oi circuits over 60U_..........__.............._---............125A0 i
f i-4 clrcuits-�57A0;Add'n circuits$(i ea)
1(a new or altcrad commercial service is 200 amps or greater,or a ne�a or altcred residential service is greatcr than 400 amps,a plan revic���is required.Fee is 3�%of
ncmiit fee+$72.50.Add'I plan revicw for other submissions is$85.50/hr.
FIXTURE DESCRIPTION A FIXTURE FEE FROM TABLE B B NUMBER OF UNITS C TOTAL D I
i I 1
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i
i_ I
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'TOTAL COLUMN D : �
�otal Coiumn�D)
Estimated Permit Fee: (12)
Estimated�ermit Fee from Gne 12
Estimated Plan Review Fee: $72.50 + ( ' X.35) _ (13)
. • .
Estimated Permit Fee: (14)
Bond Amount: (15)
Estimated Permit Fee: (16)
Bo�d Amount: (17)
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Mitigation Fee: (18) (2p� (22�
SBCC Surcharge: (19) (21) (23)
TOtal �aaqeso�,es�TWo�: Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) _ (24)
8ulletin �t 100-December 23, 2002