01-103205G
f CONSTRU(_ ION PERMIT APPLICATION
crrror
APPLICATION NUMBER: Q _ - Lam% - [e
PPLICATION NUMBER:
(aI I Y OF I'`=L7Li a ;L WH r APPLICATION NUMBER: - -
BUILDING DEPT. - - - - - - -
**The following is required information — Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY
INFORMATION
SITE ADDRESS: " �r ASSESSOR'S TAX/PARCEL 2—
�x-7 S.
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
E PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERINGk FIRE PREEV�ENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): (�o�! / Yolf� ��IC '//9r�r� �� cOwl
tam
PROJECT NAME:
jl :'M PEOPLE INFORMATION
PROPERTY OWNER: NAME:
DAYTIME PHONE:
� a- 6XFf
MATUN(141ODRESS (STREET ADORES ' CTTY, STATE, ZIP):
CONTRACTOR:
APPLICANT:
NAME
��l
MAILING ADDRESS (STREET
J 17
CITY OF FEDERAL WA BUS
CONTRACTOR'S RE-GISIUT
(colly of card required)
NAME:
ca
M UNG ADDRESS( REE
jk-
RELATIONSHiP TO PRO] C
❑ ARCHITECT
/6,
DAYTIME PHONE:
{ypDR£SS; , STATE, ZIP): y� ) EV NING PHOKC -
4G
NESS LICENS UMBER: FAX NUMBER:
ON NUMBER: �,F � tF ^ EXPIRA�'ION / /Y /
A RESS; CITY, ATE, ZIP);
O
❑ TENANT OTHER ( DESCRI
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT
D/A/yy�'7IME FHON -:
7
� / /
(✓ V L
EVENING PIIONE:
FAX NUMBER:
E-MAIL ADDRESS:
��-r 00,�S r
eCONTRACTOR
EXISTING USE: ���tx EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE: SS m l _ PROPOSED VALUATION FOR IMPROVEMENTS:
SPRINKLERED BUILDING? ❑ YES *NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED 0YES ❑ NO
WATER SERVICE PROVIDER: 0
--LA ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 HIGHLINE ❑ PRIVATE (SEPTIC)
44
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
■ PROJECT FLOOR AREAS
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)
BOILERS)
FIREPLACE INSERT(S)
RANGE(S)
MISC. ( )
COMPRESSOR(S)
FURNACES)
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S)
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
DISHWASHER(S)
RAIN WATER SYS.
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)
C
I certify under penalty 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 attorneys' 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 claim arises out of the reliance of the city, including its officers and employees, upon the accuracy
of the information supplied to the city as a part of this application. J
NAME/TITLE: DATE: `
❑ PROPERTY OWNER ❑ APPLICANT *CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
NEW RESUDENTIAL SERVICES
MOBILE HOMES
$44.25
MISC EQUIPMENT/TEMP SERVICES
N of Thermostats (First-$33.50; add'n-$10.50ea)
- Single Family
CC407.00; Each add'n 500 ft'-$21.50)
_ Service or feeder only .........................
Service and feeder ...............................
$72.25
_
K9 of Low voltage fire or burglar alarms
(First 1300
-
First 2500 11'-$38.75; Each add'n 2500 ft'-$10.50
Square Feet:
1=_ach outbuilding4r garatc .......................... $28.00
MOBILE HOME/RV PARK
Square Feet: S Z 3 S
`Per 4VAC -910(5 R ii)
_
(Inspected with service)
$44.25
_ N of service or feeders
(First service/feeder-$44.25; Add'n service/
addi
Signs (First sign-$33.50; add'n sign
_ N t sign-
F € t �.........................•
Each outbuilding -or aragc
$16.00 each)
$1
_
(Inspected separately)
feeder-$28 each)
,
_ Progress inspection per /z hr.... ...........$3350
_ Swimming pool. hot tub, spa .................67.00
Yard Pole meter loops...........................44.25
MULTI-FAMILY
NEW MULTI -FAMILY
COMMERCIAL/INDUSTRIAL
COMMERCIAL/INDUSTRIAL
Altered Service or Feeders
(Includes three units or more)
Service Feeder
Amps Service or
Add'n
- 0 to 200...............................................$ 72.25
_ U to 200 am $ 72.25................. $ 21.50
pp...............
Feeder
$ 72.25........
$ 44.25
-201-600 .............................................. 169.00
601- 1000.................------....................254.50
_ 201 - 400 amp .................. 89.75.................... 44.25
123.25.................... 61.50
_ 0 to 100..........................
101 - 200 89.75...........
56.25
-
- over 1000. •.... ... 282.75
_ 401 - 600 amp ................
_ 601 - 800 amp ................ 158.00.................... 84.25
- ..........................
_ 201 - 400........................ 169.00...........
197.00...........
67.00
78.75
- N of circuits
(1-5 circuits-$56.25; Add'n circuits- $5 ea)
Over 800 amp ............... .225.25- ................ 169.00
- 401 - 600........................
_
ALTERED SINGLE/MULTI FAMILY
_ 601 -800 ........................ 254.50.,.......
310.75.........
107.25
129.75
Temporary Service
(When inspected separately from the services.)
_ 80l - 1000......................
339.00.........
181.00
.........$38.75
0 to 60.................. ::............. ........
Service or Feeder
$ 61.50
-Over 1000 ......................
Over 600 volts surcharge ......................
56.25
,
- 61 - 100 ...................................... ......----44.25
�. 0 to 200 amp ................................................
89.75
-
Mast or meter repair .........................•--
61.50
- I01 - 200....... ,:> 56.25
p....................:.................
201 - 600 am .........
201 - 400.....------....--------•---•....................67.00
_
f over 600 amp ....... ...................................... 13525
- 401 - 600....-•-•----------•---......•----...............89.75
- Mast or meter repair . ...................................... 33.50
-
over 600-----•-•----------••-•-------•...................97.75
N of circuits
-
_
(I4 circuits-$44.25; Add'n circuits $5 ea)
IL
If service is greater than 200 amp, a plan review is rcq'd. Fcc is 35% of Iscrntit fce !ili 5. Add'I plan review for other submissions is 567.00/hr.
FIXTURE DESCRIPTION A FIXTURE FEE FROM TABLE B B
Total Column (D)
Estimated Permit Fee: (12)
NUMBER OF UNITS
TOTAL
MN
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $56.25 + X .35 = (13)
Estimated Permit Fee: (14
Bond Amount: (15) ,
Estimated Permit Fee: (16)
Bond Amount: (17)
Mitigation Fee: (18)
■ DEMOLITION
■ ENGINEERING
■ OTHER FEES
(70) - - (72)
SBCC Surcharge: (19) (21) (23)
Total (Pages one &Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) = (24)
TOTAL
Bulletin #100 -January 3, 2001