02-100769City of Federal Way
Community Development Services Mechanical Permit #: 02 -100769 - 00 - ME
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: KELTNER
Project Address: 865 S 326TH Parcel Number: 326070 0420
Project Description: MECH - Replace gas furnace in existing single family residence.
Owner
Applicant
Contractor
Richard C Keltner
ADVANCED FILTER AND MECHANICAL
ADVANCED FILTER AND MECHANICAL
865 S 326TH ST
418 VALLEY AVE NE
418 VALLEY AVE NE
FEDERAL WAY WA 98003-5935
PUYALLUP WA 98372
PUYALLUP WA 98372
(253)770-2440
Mechanical Valuation..........................................1793.95 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Deeri''tion'i' M"'�' Quariti aescri tion Qtaantld y D escrl tion Qtianti
Furnaces
v ,
PERMIT EXPIRES August 20, 2002, IF NO WORK IS STARTED.
Pe ued on February 21, 2002
I hereby certify that the abov 'forma ' n is co ct an that cons ction on the above described property and
the occupancy and the u will be i ccorda a with a law , rules r ulations of the State of Washington and
the City of Federal
Owner or age n : Date:
Mems- F�7�"'at, l C) C4 .3 - --R,- o z ez.�
��CE11/�p CONSTRUCTION PERMIT AP
`�'°� G PLICATION
•
APPLICATION NUMBER: ®2 - %0.0
FEB e
2 1 2002
APPLICATION NUMBER:
�NOFFEp�R APPLICATION NUMBER: _ _ - _ — — — — - — —
SUILDHY(3 A WAY - - - - - - - -
**The following is required information — Please print 6M ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
/ ,• .
INFORMATION
SITE ADDRESS: �` 5-510- 3 23T ASSESSOR'S TAX/PARCEL #:,3z-
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
;`. ■ . PROTECT INFORMATION
,
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING NMECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING El FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): 'p C . o Q _ e" _ , . _ e-.�
OROJECT NAME:
PROPERTY OWNER:
■ ` PEOPLE INFORMATION
NAf� DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
CONTRACTOR:
NAME:
DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
7; FFEDERAL WAY BUSINESS EN NUMBER:- � � / -
FAX NUMBER: 6 -
CONTRACT S EGISTRATION MBER:
EXPIRATION DATE:
(copy of card required)
APPLICANT:
NAME:
DAYTIME PHONE:
( )
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
RELATIONSHIP TO PROJECT:
FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE):
( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
/
PROPOSED USE- PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ElYES ElNO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUI ED: ❑YES El 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:
■ PROSECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT..
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
—'— BOILER(S)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
MECHANICAL r
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERTS) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINK(S)
SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
']iGCLATMER/STGNATURE BLC
WATER HEATER(S)
❑ ELECTRIC ❑ GAS
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 a premises to perform the work for which the permit application is made. I
further agree to hold harmless the City of Fede ay as to claim (including costs, expenses, and attorneys' fees incurred in the
investigation and defense of su aim), wh' y be de y any person, including the undersigned, and filed against the City of
Federal Way, but only whe u aim a ' ut of rel' nce of the city, including its officers and employees, upon the accuracy
of the information suPp " o city as a p of th' app ca(oq,
NAME/TITLE:
❑ PROPERTY OWNER ❑ APPLICANT
DATE:
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOX 9718 - FEDERAL WAY, WA 98063-9718 - 253-661-4000 - FAX: 253661-4129
www dWoffederalwayxom
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.
TABLE A
TOTAL VALUATION
FEE FACTOR
(1) $1.00 to $500.00
(1) $26.00
(2) $501.00 to $2,000.00
(2) $26.00 for the first $500.00 plus 53.50 for each additional$100. or 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 additional$1.000.
or fraction thereof, to and
including $25,000.00
(4) $25,001.00 to $50,000.00
(4) $435.00 for the first $25,000.00 plus $11.00 for each a&Wonl S1.000.A0
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 $8.00 for each addWonl S1.000.
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 S6.A0 for each additant S1,000.G10
or fraction there9f, 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 55.50 for each addiVonl $1.000.Lbor
fraction thereof, to and
including $1,000,000.00.
i
(8) $1,000,001.00 and up
(8) $6,260.00 for the first $1,000,000.00 plus 0,00 for eadr additional S1.AOo.00
or fraction thereof.
Bold number Is the base fee for the specified increment
itardzed, underlined number Is the fee Per add(borral soedried increment
PLUS: Add 65 percent of the base building permit fee for plan review fee.
Add 25 percent of the base mechanical permit fee for mechanical plan review fee.
f Add 15 percent of the base building permit fee for Fire District #39 surcharge, commercial only.
Add $4.50 for WA State Building lode Council, plus $2.00 per unit for duplex & above.
** Electrical, plumbing, and mechanical fees are calculated separately **
■ BUILDING
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
■ MECHANICAL
ROP •
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (4
Estimated Plan Review Fee:
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee:
Estimated Plan Review Fee: (7)
(a) Base Fee:
(b) Additional Increment Fee:
■ FIRE PREVENTION SYSTEM
(a) Base Fee:
(b) Additional Increment Fee:
0 PLUMBING
Base Fee Number of Foxes
$22.50 +(
X $8.00/fixture} _ (8) Estimated Permit Fee
Estimated Permit Fee
X .65 =
Miscellaneous Fixture Charge: (10)
Sub Tota) (Pageone): Line(s)(1)+(2)+(3)+(4)+(S)+(6)+(7)+(8)+(9)+(10) = (11)
(9) Estimated Plan Review Fee