02-105686 �•� �- CONSTRU� i iON PERMIT APPLICATION
�� ��— PPLICATION NUMBER: _ _ — � —
�-.���;;�a�,r�„�„''' PPLICATION NUMBER: — —
PPLICATION NUMBER: — — — — — — — — —
**The following'��ree�uiHe�i�Y�atiori—Piease print(i�ink)or type**
Please note: Electrical,Fire Prevention_���g�,qql�ngineering permits may require a separate application.
. � . � . �
SITE ADDRESS: _ 31H11 PdCI f 1 C HW�/ SOLIt{1 ASSESSOR'S TAX/PARCEL #: -
� LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• • � • •
TYPE OF PitOJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERINCy�FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): AdCI 4� spri nkl er heads
PRo�Ec��NnME: __ LensCrafters - Pavi 1 i on I I C n - r
. • . • .
PROPERTY OWNER: NAME: DArr[ME Pf10NE:
� � -
MAIUNG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE: �
Crown Fire Protection Inc. (425 ) 481 - 7669 �
MAIUNG AODRESS(STREET A�DRESS;CITY,S7ATE,ZIP): EVENING PHONE: I
P.O. Box 12113 Mill Cree (425 ) 481 - 7669
QTY OF FEDERAL WAY BUSINESS UCENSE NUMBER� � 1 ��� � � � ��ry �R��/ -���5
UMB
�5
CONTRACTOR'S REGISTRATION NUMBER: E7(PIRAT70N DATE:
(copy o(tard required) C R 0 W �y E p � 4 4 L L � � � � �
APPLICANT: NAME: �nmME rr�oNE:
C � � _
MAILING ADORESS(STREET AD�RESS;C[TY,S7ATE,ZIP): EVENING PHONE:
( ) - �
RELATIONSHIP TO PRO]ECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): � � -
E-MAIL AODRE55:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ��APPLICANT ,�CONTRACTOR
� • . . . • •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ ,/'T���/
i SPRINKLERE� BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
� WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
�
**ryEW RESIOENTIAL CONSTRUCTION ONLY**
NUME3ER OF BEDROOMS: ESTIMATED SELLING PRICE: $
- • • . •
FLOOR EXISTING S .FT. PROPOSED S .Ff. TOTAL
BASEMENT . _
FIRST
SECOND
THIRD
FOU RTH '
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.S�,,STEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSfOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC �AS
PLUMBING
BATHTUB(S) IAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINtQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) _ SUMP(S)
. •
I certify under pena(ty of perjury that the informatio�furnished by me is true and correct to the best of my knowledge,and
furtfier,tfiat I am authorized by the owne�of the above premises to perform the work fo�which the pern�it appliption is made. I
furtfier agree to hold harniless the City of Federal Way as to any daim(induding costs,ezpenses,and attomeys'fees incurred in the
investigation a�d defense of such daim),which may be made by any person,i�duding tfie undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the aty,induding its officer-s and employees,upon the accurecy
of the infortnatio uppli d to the dty as a part of this applica�ion.
' � DATE: ���C����
NAME/TITLE: -
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
_ _ _ _...
❑ NEW�: � ' ❑ ADDITION ❑ ALTERATION ❑ REPAIR � TENANT IMPROVEMENT =' �
CENSUS"CODE: ` `LOT SIZE:
ZONINGIDESIGNATION: E3UILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION' BASIC PLAN? ❑ YES ❑ NO �
SECTION s . TOWNSHIP RANGE NEW ADDRE55 REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ' ❑ YES ❑ NO CNANGE OF USE? ❑ YES ❑ NO : �
COMMUNCTY DEVELOPMENT SERVICES•33530 FIRST WAY SOUT}i•PO 60X 9718•FEDERAI WAY,WA 98063-9718-253-661-4000•FAX:253�61-4129
www cityoffederalway.com '
,
Constr'�fction Permit Fee Calculation �et
*******PLEASE NOTE: ALL FEES MUST�E VERIFIED BY CITY STAFF PRIORTO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WsLL NOT BE ACCEPTED!*******
Building,mectianical,and fire prevention system fees are based on the foilowing sctiedule. _
. TABLE A
TOTP,L VALUATION FEE FACTOR
. (i);i.00 co Ssoo.00 (i);z6.00 �
(2);501.00 to SZ,000•00 (2)$26.00 for the first;500.00 pius�3.50 for each additionalSIG1200or fradio�tfiereof,to and including
12,000.00
(3)4z,001.00 co Szs,000.00
(3)�78.50(or tfie first;2,000.00 Plus SIS50(o�each addi[ional3l,OOO.A�or fradio�tfiereof,to and
indudi�g$25,000.00
(4)525,001.00 to SS0.000.00
(4)5435.00 fo�tfie first$25,000.00 plus,�II.IXI foreach addifiona/SI,LI�O.A�o�fradio�thereof,to and
induding$50.000.00.
(5)SS0,001.00 to$100,000.00
(5)$710.00 fo�the first;50,000.00 plus 58.00�or each additana/SI,OOO.00or fraction thereof,to and
induding$100,000.00.
(6)5100,001.00 to j500,000.00
(6);1,110.00 fo�tfie first;100,000.00 plus f6.00foreach additiona/SI,OLY1.00or fradion there9f,to and
induding$500,000.00 .
(7)5500,001.00 to$1,000,000.00
(�$3,510.00 for tfie Tist;500,000.00 plus SS.SO fo�each additanalSI,OUO.A�or f2cYion thereof,to and
i�duding$1,000,000.00. i
(8)$1,000,001.00 and up
(8)$6,260.00 for the first;1,000,000.00 plus S4.A�for eacfi addi[ana/SI.OrI0.GY7 or fraction thereof.
Bold numbe�is the base fee fo�the specified increment
Ita6dzed under/ined number is tfie/ee per addi6%ana/soeciFied inc-rement
PWS: Add 65 percent of the base building permit fee for plan review fee.
Add 25 percent of the base mechanical permit fee for medianical plan review fee.
Add 15 percent of the base building permR fee for Fre Distrid#39 wrcharge,commercial oNy.
Add#4.50 fo�WA State Building Code Cou�dl,plus$2.00 per unit for duplex&above.
� ■*Eiedrical,plumbing,and mechanical fees are calculated separately**
.
, ?ROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
� (b)Additio�al Inaement Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
I� Estimated FW Fre Department Surcharge: (3)
� (COMMERQAI.ONL`�
I
� PROPOSED VA�UATION:
{
r FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Inaement Fee:
Estimated Pertnit Fee: (4)
i
IEstimated Plan Review Fee: (5)
I .
� PROPOSED VAIUATION: �, /(�(/•�
; FEE FACTOR FROM TABLE A: Number:�_ (a)Base Fee: ,Sv
(b)Additional Increment Fee: �`�
Estimated Permit Fee: (6) ��(0��
' Estimated Plan Review Fee: (7)
Base Fee Number of Fahxes
, $22.50 +{ X$8.00/fixture}_ (8)Estimated Perrnit Fee
Estimacea Pe.rnic Fee
X .65= (9) Estimated Pla�Review Fee
Miscella�eous Fxtu�e Charge:(10)
Sub Total �Pageo�,e�: Line(s)(1)+(2)+(3)+(9)+(5)+(6)+(7)+(8)+(9)+(10) _ (11)