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)