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02-102582City unity Development Services Federal Way mun ComMechanical Permit #: 02 - 102582 - 00'- ME 33530 1 st Way S Federal Way, WA 98003-6210 Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050 i Project Name: NELSON Project Address: 1240 SW 296TH Parcel Number: 062104 9047 Project Description: MECH Install gas hot water heater and gas furnace for existing residence. Includes gas piping. Owner Applicant Contractor CHRISTIAN S & JENNIFER S NELSON ROSSOE ENERGY SYSTEMS INC ROSSOE ENERGY SYSTEMS INC 1240 SW 296TH ST 9367 RAINIER AVE S 9367 RAINIER AVE S FEDERAL WAY WA 98023 SEATTLE WA 98118 SEATTLE WA 98118 (206) 725-7555 Mechanical Valuati n ..........................................3288 Over the Counter Permit......................................Yes Mechanical Fixtures Descr fptiorl G2tr i ` 16"0 1" ,a►lt Furnaces 1 Gas Piping 1 PERMIT EXPIRES December 17, 2002, IF NO WORK IS STARTED. Permit issued on June 20, 2002 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington and the City of Federal Way. See Application Owner or agent: Date: I i' City Federal Way Applicant Mechanical Permit #:02 - 102582 - 00 - ME Community Development Services Commm» ROSSOE ENERGY SYSTEMS INC _ 33530 1 st Way S 9367 RAINIER AVE S 9367 RAINIER AVE S Federal Way, WA 98003-6210 SEATTLE WA 98118 SEATTLE WA 98118 Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050 J Project Name: NELSON Project Address: 1240 SW 296TH Parcel Number: 062104 9047 Project Description: MECH - Install gas hot water heater and gas furnace for existing residence. Owner Applicant Contractor CHRISTIAN S & JENNIFER S NELSON ROSSOE ENERGY SYSTEMS INC ROSSOE ENERGY SYSTEMS INC 1240 SW 296TH ST 9367 RAINIER AVE S 9367 RAINIER AVE S FEDERAL WAY WA 98023 SEATTLE WA 98118 SEATTLE WA 98118 (206) 725-7555 Mechanical Valuation..........................................3288 Over the Counter Permit......................................Yes Mechanical Fixtures Degc69ia'rT' 6 iV r" Quantr Y f7eseri tion Quaritit ��`` ;:t3escri tion Quantit Furnaces 1 PERMIT EXPIRES December 17, 2002, IF NO WORK IS STARTED. Permit issued on June 20, 2002 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington and the City of Federal Way. Owner or agent: i ll - Date: 0 �� _ `?i 4 �� _ coM RFCF"Y CONSTRUCTION PERMIT APPLICATION � F�OERF3L_ ��MMU �p�� F11CATION ��PYE, HONNUMBER: DZjU�O2O0 NUMBER:TION NUMBER: **The following is required information — Please print (ih ink) or type** " Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. WVROPERTY INFORMATION SITE ADDRESS:" 1() 2/ 50 57�. ASSESSOR'S TAX/PARCEL #: D to Z LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): • • • TYPE OF PROJECT (This application): 11 BUILDING �4 PLUMBING MECHANICAL ❑ DEMOLITION ELECTRICAL ENGINEERING❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description): s -r /T L.L.- 946 IC"2,J4 A) 4C PROJECT NAME: PROPERTY OWNER: CONTRACTOR: ;r APPLICANT: CONTACT PERSON PEOPLE INFORMATION NAM" xo s5O ��,�/�ka x � y5 . DAYTIME PHONE: t > 7,z�6-- 7 sem! MNG ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): _ 3& / 44/A)/kA S . 9 EVENING PHONE: I ( > - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: i — S — / 0 5-583 - 0 0-_`R/-__ - FAX NUMBER: c - CONTRACT 'S REGISTRATION NUMBER: c , S o S / EXPIRATION GATE: d / / Q (copy of card required) T / / NAME: (DAYTIME PHONE: / I MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE: I RELATIONSHIP TO PROJECT: FAX NUMBER: ❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE): ( - =0R THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT XCONTRACTOR E-MAIL ADDRESS: PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ SPRINKLERED 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) **NEW RESIDENTIAL CONSTRUCTION ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ . ■ PROIECT FLOOR AREAS FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL BASEMENT FAN(S) HOOD(S) WOODSTOVE(S) FIRST FIREPLACE INSERTS) RANGE(S) MISC. ( ) SECOND { FURNACE(S) THIRD _ GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC GAS FOURTH PLUMBING OTHER FLOORS (DESCRIBE) DECK LAVATORY(S) URINAL(S) WATER HEATER(S) GARAGE HOW MANY FLOORS? RAINWATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC )KGAS TOTAL' SHOWER(S) WASH MACHINE OUTLET 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 INSERTS) RANGE(S) MISC. ( ) COMPRESSOR(S) { FURNACE(S) DUCT(S) _ GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DISHWASHERS) RAINWATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC )KGAS DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. ( ) INTERCEPTOR(S) SUMP(S) 'ITCCI ATMFR/CTr..NAT11RE RLC I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and 6i ther, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I �rther agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attomeys' fees incurred in the vestigation 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 elf the information supplied to the city as a part of this application. NAME/TITLE: ��/�/ / �� DATE: / C. PROPERTY OWNER ❑ APPLICANT XCONTRACTOR FOR OFFICE USE ONLY: NEW ❑ ADDITION E]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 COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOK 9718 - FEDERAL WAY, WA 98063-9 71 8 - 253-661-4000 - FAX: 253661-4129 wuvw.0 tvoffedera Iway. com Construction Permit Fee Calculation Sheet '*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CITY STAFF PRIOR TO ACCEPTANCE OF PAYMENT. CHECKS FOR INCORRECT AMOUNTS WILL NOT BE ACCEPTED!******* Building, mechanical, and fire prevention system fees are based on the following schedule. y PLUS: TARIFA TOTAL VALUATION FEE FACTOR (1) $1.00 to $500.00 M$26-00 (2) $501.00 to $2,000.00 (2) $26.00 for the first $500.00 plus 53.50 foreach additional$100.00or fraction thereof, to and including $2,000.00 (3) $2,001.00 to $25,000.00 (3) $78.50 for the first $2,000.00 plus $15.50 for each addition/ 51,01x1.00 or fraction thereof, to and including $25,000.00 (4) $25,001.00 to 150,000.00 (4) $435.00 for the first $ 25,000.00 plus 511.012 for each additional 51.000.00 or fraction thereof, to and including $50,000.00. (5) $50,001.00 to $100,000.00 (5) $710.00 for the first $50,000.00 plus 58.00 for each additional S1.000.00 or fraction thereof, to and including $100,000.00. (6) $100,001.00 to $500,000.00 (6) $1,110.00 for the first;100,000.00 plus 56.00 for each additional S1.000.00 or fraction thereof, to and including $500,000.00 (7) $500,001.00 to $1,000,000.00 (7) $3,510.00 for the fist $500,000.00 plus $5.50 for each additional $1,000.or fraction thereof, to and including $1,000,000.00. (8) $1,000,001.00 and up (8) $6,260.00 for the first $1,000,000.00 plus $4.00 for eadi additional51.000.00 or fraction thereof. Bold number is the base fee for the specified increment Itarared, underlined number Is tfie fee per addWortal soedred Increment Add 2S percent of the base mechanical permit fee for mechanical plan review fee. Add'15 percent of the base building permit fee for Fre District #39 surcharge, commercial 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 TABLE A: Number: Estimated Permit Fee: (1 Estimated Plan Review Fee: (2) Estimated FW Fire Department Surcharge: (3) (COMMERCIAL ONLY) ■ BUILDING -I (a) Base Fee: (b) Additional Increment Fee: 0 MECHANICAL PROPOSED VALUATION: - FEE FACTOR FROM TABLE A: Number: (a) Base Fee: 7-9 • 6 31 (b) Addition crement Fee: W Estimated Permit Fee: (4) Estimated Plan Review Fee: (5) PROPOSED VALUATION: ,` - • % l� FEE FACTOR FROM TABLE A: Number: (a) Base Fee: (b) Additional Increment Fee: -` Estimated Permit Fee: (6) Estimated Plan Review Fee: (7) op, Base Fee Number d Rxtures $22.50 + { X $8.00/fixture) - 3d ' ;� (8) Estimated Permit Fee Estimated Permit Fee X.65 = (9) Estimated Plan Review Fee Miscellaneous Fixture Charge: ( ) Sub Total (Page0ne): Line(S)(1)+(2)1-(3)+(4)+(S)+(6)+(7)+(8)+(9)+(10) = (11)