03-100226 . . ` CONSTRUCI � PERMIT APPLICATION
CITY OF �.r./ p pp���ON NUMBER: v3 - L d Q � -
�9�..( Y' F�t� � i„` —
Federal Way PP��noN N�MBER: _ _ - _ _ _ _ _ _
: , , � „., -i PPLICATION NUMBER: — — — — — — — — — —
s .
*�The following is required information-Please print(in ink)or type**
Please note: Electrical Fire Preventi n S ��� a .Q�n ineerin ermits ma re uire a se arate a lication.
, 9 , Y�m�, P 9 9 P Y 9 P PP
. � . � . �
I
I / ^ �y��. ' ''/`' V
SITE ADDRESS: � �!�p'iS 1�I�,��I�Mi� N�►�j�r �•ASSESSOR'S TAX/PARCEL #: _ _ _ _ _ _ - _ _ _ _
LEGAL DESCRIPTION OF SUB)ECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• � � • �
TYPE OF PROJECT(This application): ❑ BUILDING o PLUMBIfdG ❑ MECHANICAL o DEMOLITION
1dELECTRICAL � ENGINEERING o FIRE PREVENTION SYSTEM
T�
PROJECT DESCRIPTION (Provide detailed description): ��.1���� ✓�Q,W" I'�'rC- ��TM J�,/ �`-��
PRO]ECT NAME: f �i 4 i �� ; �-'���� ��i t `L.� �7 SCI ' �
• • • � •
PROPERTY OWNER: N^ME: ; DAYTIME PHONE
A�C N ►���'� nsc �Mpp�►,�s � �a�a ��3-40 6�
MAILING ADDRE55(STREET ADDRESS;CITY,STATE,ZIP):
;�50 9 aL���.GJP4 �S�iTE )o� ���. C�A 9 B t a 1 ;
CONTRACTOR: Narte � , � DAYTIME PHONE: ;
� ' S • �D A � ' (�-�5)�-5� - �
`�+`./v / I � �� RESS(STR ,qD E��'. TE.Z� ��I V i EV��NG PHONEr _ �� i
rt r.,r�$�
CTTY OF EDERAL Y BUS E55 LiCENS UMBER: , FAX NUMBER: '
��,�p���� a _ - Q _ �e 1 �_ �. i � -�SSZ�
CO CTOR'S REGISTRATION NUMB I D(FIRATION DATE:
��WY of card required) �,! �/��_ �' I � �
APPLICANT: NAME: DAYTIME CHONE:
� �$��I�� �'��C''T1z1C, � t�a5)$8'8
MAILING ADDRESS(STREET AODRESS;C7TY,STATE,ZIP): ; EVENING PNONE' -���0 I
i �►o. s�� aq�Q N��r��;� waqgo4s ; c ; - !
i RELATIONSHIP TO PRO)ECT: � FAX NUMB.R: !
I o ARCHITECT ❑ TENANT o OTHER( DESCRIBE): ` (L}��1�$ "���' I
; E-M—A�RE55:
I I
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER o APPLICANT ❑ CONTRACTOR �
� � : � • • •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION ;
yl -, �
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ r^�'�'��
SPRINKLERED BUILDING? �YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED f�YES O NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o NIGHIINE o TACOMA O PRIVATE(WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE o PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ON „� ,
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: �
• • • . •
FLOOR EXISTING S .Ff. PROPOSED S .FT. TOTAL
BASEMENT
�Rsr ���p� p
SECOND
;
I
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of ach type of fixture
MEC ANICAL
AIR HANDLING UNIT(S) ' EV PORATIVE CO ER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FA (5) HOOD(S) WOODSTOVE(S)
BOILER(S) FI EPLACE INSER (S) RANGE(S) MISC.(__ )
COMPRESSOR(S) F RNACE(S)
DUCT(S) G S PIPE OUTL (S) � HEAT SOURCE: ❑ ELECTRIC ❑ GAS
LUh9BY(d
BATHTUB(S) VATORY(S) U NAL(S) WATER HEATER(S)
DISHWASHER(S) N WATER S. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
. •
I certify under penatty 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 attomeys'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 daim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information sup lied to the city as a part of this application.
NAME/TITLE: � i �L'� � DATE: � � � ���'��
❑ PROPERTY OW ER o APPLICANT ❑CONTRACTOR
FOR OFFICE USE ONLY:rr
_ _ _
�NEW ` ." o"ADDITION : o ALTERATION =. 'o REPAIR'. " ' ❑TENANT IMPROVENIENT�
��CENSUS'CODE:�-�� � �LOT SIZE:�- �- - � --
'ZONINGDESIGNATION:�� - '..-' ' _ _�=- _, "'��`.�;' BUILDING�SNELL�ONLY7;��� o YES��
�= �p NO � ��� �`
COMP PLAN DESIGNATION - BASIC PLAN2,� �'�❑ YES ❑ NO�����'"�
SECTION--- .'-- TOWNSHIP ," 'RANGE :- NEW ADDRESS RE UIRED7 � ❑ YES ,❑ NO
PLATTED:LOT?. `❑YES .❑ NO ' `':�' ` ' CHANGE OF USE?" ... : ❑YES' "t� NO `
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253�i61�000•FAX:253�61�129
www.dtvoffederalway.com
� � Con�ction Permit Fee Calculation `!�(eet
*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CI7Y STAFF PRIORTO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WILL NOT BE ACCEPTED!*******
Building,mechanical,and fire prevention system fees are based on the following schedule.
TABLE A
' TOTAL VALUATION FEE FACTOR
(i>Si.00 co isoo.oa �i);so.00
, (Z)SSO1.00 to SZ,000•00 (2);30.00 for the TinY s500.00 plus,f9.LY)for each additionalSIA9OOor fradion tfiereof,to and including
$2,000.00
(3)Sz,001.00 to 525,000.00
(3)�90.00 for the first;2,000.00 plus,�IB.A9 for each additiona/SI,OOO.OiOor fradion thereof,to and
induding$25,000.00
(4)$25,001.00 to 550,000.00
(4);504.00 for the Tirst;25,000.00 plus�13.L1�foreach additiona/SI OA�OOor fradion thereof,to and
� Including$50,000.00
(s)iso,00i.00 co;ioo,000.00
(5);829.00 for the�rst;50,000.00 plus 59,01�for each addifionalSl OIXJ 00 or fradion thereof,to and
inciuding�100,000.00
� (6)Sioo,00i.00 co gsoo,000.00
(6);1,279.00 for the flrst;100,000.00 plus l7.00 for each additional SI.O(XJ IXJ or fradion thereof,to and
including$500,000.00
(7)Ss00,001.0o co;1,000,000.00
(�$4,079.00 for the fist;500,000.00 plus,�6.LYl for each additiona/Sl.(XJOOr1 or f2ction thereof,to and
Indudin9 s1.000,000.00
(8)51,000,001.00 and up
� (8);7,079.00 for the first s1,000,000.00 plus 54.50 foi each additiona/SI,DOD.L1�or fraction thereof.
Bold number is the base fee for the specifled Increment
Ita/Idzed,unde�/ned number/s the lee aer additfona/sved�ied/narment
PLUS: Add 65 percent of the base building permit fee for plan revlew fee.
! Add 25 percent of the base mechanical permK fee for mechanical plan review fee.
Add 15 percent of the base building permit fee for Fire DisUict#39 surcharge,commerdal only.
Add$4.50 for WA State Building Code Council,plus$2.00 per unit for duplex&above.
**Electrical,plumbing,and mechanical fees are calculated separately**
PROPOSED VALUATION: •
FEE FACTOR FROM TABIE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
� Estimated FW Fire Department Surcharge: (3)
t (COMMERQAL ONLI�
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additionai Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
•
PROPOSED VALUATION: e�Ob�
FEE FACTOR FROM TABLE A: Number:� (a)Base Fee: �
� (b)Additional Increment Fee: �
Estimated Permit Fee: (6) l �
Estimated Plan Review Fee: (7)
Base Fee Number of Fbctures
$26.00 +( X$9.00/fixture} _ (8) Estimated Permit Fee
Esamaced Perrnrc Fee
X .65 = (9) Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
Sub Total �raye a,e>: Line(s)(1)+(2)+(3)+(q)+(5)+(6)+(7)+(s)+(9)+(10) _ (il)