03-102663 , ` R�(� ��� CONSTRUCTI PERMIT APPLICATION
� ury oF �� pp�GqnON NUMBER: Q - � -
� Federal Way :,,N �, o �003 ppLICATION NUMBER: _ _ - -
:r L� _
F FE[7E�ALTiNA`l PPLICATION NUMBER: _ _ - _ - - - - - -
! 'Y�fi1���v���jsQ�ufted information—Please print(in ink)or type"
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� Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
. � . � . �
SITE ADDRESS: ���'� T A� • ��Y+ � • ASSESSOR'S TAX/PARCEL #: (���1 Q�- � C gj �
LEGAL DESCRIPTION OF SUB)ECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
�� � ��1-� 03--1015��—ov�—cfi,
� • . . • .
TYPE OF PROJECT(This application): o BUILDING o PLUMBIf�dG ❑ MECHANICAL o DEMOLITION
❑ ELECTRICAL o ENGINEERING�FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): �""�V� �[�- � ��C,,�`"'r'c'� �� 1 `j���N�S—..�,�
�t '� '�I��IA�f�`-r )YVt'P���o'Yt�l�TS,
PROJECT NAME• ___ �'�� ����C�_
I � � � � �
� PROPERTY OWNER: N^ME: ; DAYTIME�HONE _
1 ( � j
MAIIING ADORESS(S�REET ADDRESS;CITY,STATE,ZIP):
�
i �
CONTRACTOR: NAME: ; DAYfIME PHONt: ;
t ��'��" �y��S Sl��`T ! �7_�53 )td33--�''�-g' '' �
I MAILING AODRESS(STREET A DRESS;CITY,STATE.ZIP): EVENING PHONE� �
� �.1� ��6�. �- K��� �@��-c��c,�/f�98o��'1( ) - ,�i
CITY OF fEOERAL WAY BUSINESS LICENSE N MBER: � FAX NUMBER: i
' - I ( ) - I
CONTRACiOR'S REGISTRATION NUMBER:
� D(PIRAIION DATE:
��oPY of ord required) �� `�� ]L"�.1 Q (� � b� / �� � ��
APPLICANT: NAME: DAYTIME PHONE: �
; J�t� �-vPr��- w/ �;�����" ��Y�� t�s3)��3-- i z.4� �
MAILING AOORESS(STREEf ADDRE55;CITY,STATE,ZIP): ` EVENING PHONE i
� � � i -
� RELATIONSHIP TO PRO)ECT: � FAX NUMB�R:
I O ARCHITECT O TENANT �OTHER( DESCRIBE): CtiNTr-�-C'"Ja� j �25�� '�75� —�(1'3 I
; E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PRO]ECT: o PROPERTY OWNER ❑ APPLICANT �CONTRACTOR J}�y►1�j� ���s YS�jD'y1�YJ 'E�^T�
G�YH
. . : . • • •
iEXISTING USE: EXISTING BUIIDING ASSESSED/APPRAISED VALUATION �
ROPOSED USE: PROPOSED VAtUATION FOR IMPROVEMENTS: � Z.I ?J��
' SPRINKLERED BUILDING? �YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES o NO
WATER SERVICE PROVIDER: O LAKEHAVEN o HIGHLINE O TACOMA D PRIVATE(WEIL)
SEWER SERVICE PROVIDER: O LAKEHAVEN O HIGNIINE ❑ PRIVATE(SEPTIC)
#*NEW RESIUENTIALCONSTRUGTION O '" **
NUMBER OF BEDROOMS: ES7IMATED SELLING PRICE: � �'
i,
- • • • • � ;
FLOOR EXISTING S .FT. PROPOSED S .FT. TOTAL
BASEMENT I
FIRST �
SECUND �
THIRD
FOURTN
07HER FLOORS(DESCRIBE)
DECK
�
GARAGE �
HOW MANY FLOORS7
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(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S) �
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑GAS
PLUN96YNG • I
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) �
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC ❑ GAS +
DRINIQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET 1
GAS PIPE OUTIET(S) SINK(S) WATER CLOSET(S) MISC.( ) +
INTERCEPTOR(S) SUMP(S) �
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I certify under penalty of pe�jury'that the informatio�furnished by me is true and correct to the best of my knowledge,and �
further,that I am autho�ized by the owner of the above premises to perfortn the work for which the permit application is made. I �
further agree to hold hartnless the City of Federal Way as to any daim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any perso�,induding the u�dersig�ed,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the dty,i�duding its o�cers and employees,upon ifie accuracy
of tfie(nformation suppli e a as a part o this application.
NAME/TITLE: DATE:
�p 27���
O PROPERTY OW ❑ PPLICANT �CONTRACTOR
/
FOR OFFICE USE ONI.Y
c,::�. � .:.. �.� ....�: � ,.�,x.x.��.,... ::, .�,;,. �,�,.�. � j,..:,: ,_ .�: ,._w. �: �.,��„
aU:.NEW"����rADDITION��Q ALTERATION���n.REPAIR,�;�,�.��xTENATiT-IMPROVEMENT��.�� •�•
rCENSUS:`CODE�;�z�����.�,r�,���"���E�:���` LOT.SIZE:� �".
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'ZONING:DESIGNATION;_�, �,� �.��.��„�..,�"���,,��BUIIDING SHELL ONLY7� ❑YE5''....-o NO y .,,.,
_: . ,., .:. x,.... .�.. I
COMP PLAN DESIGI+IATIUN �„ �� ��s���';;,,���, �BASIC PLAN?'��=[7¢YES ;�: �d.NO:f�z.,�; x ' ��
,SECTIUN-�t�;�.�TOWNSHIP ��' `R/1NGE�!�� �NEIM AUDRESS RE� UIRED?, , �',.�: �❑YES _��o'NO ,
P.U1TfED�LOT? '��`o YES:�; o NO ,�"����������� �CFiAN6E OF�USE7; �� -�"ti YES'�=o NO ,
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOIJTN•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253�i61-4000•FAX:253-661�129
www cttvoffederalwav com
Consfi�,tion Permit Fee Calculation $�et
*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CITY STAFF PRIUR TO A � T�iNCE OF PAYMENT.
CHECKS FOR IN��F�7'AMOUNTS WILL NOT BE ACCEPTED!*******
Buiiding,mechanical,a b fire prevention system fees are based on tfie followi�g sd�edule.
TABLE A
TOTAL VALUATION FEE fACTOR
(i);i.00 co Ssoo•oo (i)sso.00
' (z)5501.00 to 52,000•00 (2)s30.00 for the first;500.00 plus f9,A��oreach additiona/SIA�.A�or fraction tfiereof,to and induding
S�,000.00
(3)52,001.00 to 5�.�•�
(3);90.00 tor tfie(rst;2,000.00 plus�18.00 fo�each addifionalSl.O�,A9or fraction thereof,to and
induding Su,�0.00
(4)525,001.00 to SS0,000.00
(4)�504.00 for the first;25,000.00 plus S13.00foreach addQiona/SI,ALYI.00or frad'an thereof,W and
Induding SS0,000.00
(S)550,001.00 to$100,000.00
(S)�829.00 for the first 550,000.00 plus S9.A�fo�eaoh add'�[ana/SI.OIOb.IX)or(raction thereof,to and
induding;100,000.00
► (6)5100,001.00 to j500,000.00
(6)s1,279.00 tor the ftrst j100,000.00 plus S7.A�foread�addifiona/SI.DOY).00or fraction thereof,to and
induding SS00,000.00
(�SS00.001.00 to 51,000,000.00
(��4,079.00 for the Tist j500,000.00 pius S6.A�for eadr additional SI.A7rJ,G�O or fraction thereof,to and
k�d�ng$1,000.000.00
(8)�1,000,001.00 a�d up
(8)�7,079.00 for the first�1,000,000.00 plus.f4.50 for eaoh add'itiona/SS.A�IXI or fraction thereof.
Botd number Is the base fee for tfie spedtied increment
!Ya//dred.underllned number/s the fee aeraddfdona/snedried/nrnemmf
PLUS: Add 65 percent of the base buliding permit fee for plan review fee.
Add 25 percent of the base mechanical permlt fee for mechaNcal plan revlew fee.
Add 15 percent of the base building pertnit fee for Flre Distrid#39 surcharge,commercial only.
Add$4.50 for WA State Building Code Counal,plus$2.00 per unit for duplex&above.
�s Eiectrical,plumbl�g,and mechanicai fees are calculated separately*�
�
PROPOSED VALUATION: $�� ��
FEE FACTOR FROM TABLE A: Number: (a)Base Fee: —1� i
(b)Additional Increment Fee:
Estimated Permit Fee: (1) ��o�"�
Estimated Plan Review Fee: (2) J ZJ�
Estimated FW Fire Department Surcharge: (3) '� 1��
(OOMMERQILL ONL'�
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
� 1 eb •
PROPOSED VALUATION: � GrI�U� 4
FEE FACTOR FROM TABI.E A: Number:�� (a)Base Fee: � � _ �o� i�1T
���(b)Additional Inaement Fee: CQD �
Estimated Permit Fee: (6) t� ✓ f� �-� F.17,
• Estimated Pian Review Fee: (7) �7� f �� �- 4� ��.�
� �
• Base Fee Number of FbcWres
$26.00+{ X$9.00/fixture}_ (8)Estimated Pertnit Fee
esnmacea verm�c Fee
' X .65= (9)Estimated Pla�Review Fee
Miscelianeous Fxture Charge:(10)
SUb TOte) (ra4eone): Line(s)(1)+(2)+(3)+(4)+(5) (6 �� �s�+�9�+�io�_ �ii� _ '� �� � �"'—
�irG}5° St,��c�s�,= 7
,
i
TABLE B �
f ,
NEW RESIDENTIAL SERVICES MOBILE HOMES �� MISC EQUIPMENT/TEMP SERVICES �
Single Family = Service or feeder only.........................$57.00 N ofThermostau(First-$43.00;add'n-$13.00ca)
(First 1300 ft�-�RS.SQ fach add'n 500 ft -$27.50) _Scrvice and(ccdcr_............._.............�93.00 _#of Low vol[age firc or burglar alarnu
�quarc 1`ccc _ firs�2500 ft'-550.00;i;ach add'n 2500 ft`-513(i0
Gach outbuildin�or ara c.............___._._.-�3�.50 S uarc Fect:
g � MOBILE HOME/RV PARK q
(inspcctcd��ith scrvicc) d of service or Ceeders `Pcr WAC 296-46-910(5)(b)(i K ii)
Each outbuilding or gara�c.......__................�57.00 (Pirst service/Ceeder-$57.00;Add'n servicc/ _�of Signs(Pirst sigm543.00;add'n sign
(Inspccted scparatcly) feeder-$37 each) $20AU each) �
I _Swimming pool,hot[ub,spa._.........._$8S.ti0
� Yard Polc mctcr loops......_..__ . _....�57.pO �
— �
i
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAI COMMERCIAL/INDUSTRIAL �
� (I�cludcs thrcc unrt.or morej Alter�d Scrvice or Fecders �
� Scn�ice Pcedcr nmps �er��c�or ndd'n _Oto200...............___....__...............� 93.:1U i
Up to 2(NI amp............S 93.OG.._...._..__� 2ZSG Peeder _201 -600_................................... _..._.216.SG ; •
_20i -a0fi amn_... ........ i 15.5U..........._.......S7.00 0[o IOO.........................g 93.00....._� 57.00 60i -IOOU._.--..._........__...._...........-.326.SU i
I 901 -6W amp................158.50....................78.50 _101 -200........................ 115.50...........72.SU _over 1000............................................_363.Of �
G01-800 amp................202.50.................. 108.50 _20i -aOG.........-..............216.50...........$S.Sd _k ot circuits `
O�•cr 80U amp_ ..............2F9.50..................216.50 _401 -n00........----......_... 252.50......... IOI.OG 11-5 circuits-$72.50;Add'n circuits,�6 eai
ALTERED SINGLE/MUITI FAMILY 601 -$00........................326.SG.........138.00 •
(When inspected separately from the services.) _801-1�00......................399.OG....._...166.50 TEMPORARY SERVICE
Scrvice or Feeder _Over 1000......................434.50.........232.00 Residential/Multi-Family/Commerciai/Indusvial
=0[0 200 amp...............................................$ 71.50 _Over 600 volu surchazge......................72.SU 0-100.......................................--.....$ 57.00 I
201 -60U amp.............................................. 1 I5.50 _Masc or meter repair.........-�--•--......---.....78.50 101 -200................................................72.SC i
ovcr60U amp........_...................................... 174.UU _20t-400.................._.....--_...._............8�.50 �
Mast or metcr repair ._.........................._...._.43.00 40i -600..............._................_....__..i 1 i.SU i
� n oi circuits over 60G............. ...___......._.._.----.-__12�.OU (
i i-4 circuits-$5%.00;ndd'n circuits$6 ea)
I(a ncH�or altercd commercial service is 200 amps or grcater,or a ne���or altcrcd residential servicc is greater than 400 amps,a plan revic�v is required.I�ce is 3�%of
nc'rmit fce+$72.50.Add'I plan revie��-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 �
i
� � � i
1
I �
L � 1 !
TOTAL COLUMN D : �
Total Cdumn�D)
Estimated Permit Fee: (12)
� Estimated oermit Fee 6om line 12
Estimated Plan Review Fee: $72.50 + ( X.35) _ (13)
. . .
Estimated Permit Fee: (14)
Bond Amount:(15)
Estimated Permit Fee:(16)
/
Bond Amount: (17)
•
Mitigation Fee: (18) (2p� (ZZ)
SBCC Surcharge: (19) (21) (23)
TOtal �Pa9eso�,e&rWo�: Une(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18j+(19)+(20)+(21)+(22)+(23) _ (24)
8ulletin #100—pecember 23, 2002