03-102004a
City of Federal Way
Community Development Services
33530 1 st Way S
Foderal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Mechanical Permit #:03 -102004 - 00 - ME
Inspection request line: 253.835.3050
Project Name: ST FRANCIS ELEVATOR ROOM
S
Project Address: 34515 9TIS Parcel Number: 750451 0020
Project Description: Installing new chiller/pumps and 2 fan coil units serving the elevator machinery room
Owner
Applicant
Contractor
Hospital Bsp StFrancis
ACCO ENGINEERED SYSTEMS
ACCO ENGINEERED SYSTEMS
2002 ADV DEP PD 5282869
ACCO ENGINEERED SYSTEMS
ACCO ENGINEERED SYSTEMS
835 N CENTRAL AVE
835 N CENTRAL AVE
KENT WA 98032
Mechanical Valuation..........................................110000
Over the Counter Permit......................................No
I hereby certify that the at
the occupancy and the use
the City of Federal Way.
PERMIT EXPIRES January 19, 2004.
Permit issued on July 23, 2003
information is correct and that the construction on the above described property and
bg in accords with the laws, rules and regulations of the State of Washington and
Owner or agent: 11MM Date: D1- 23 ✓ b3
9�2,3/�3 S�r✓d� OJT
�n� 1
+ clTv of CONSTRUCTION PERMIT APPLICATION
`. ���„''.�' Q
PPLICATION NUMBER: 0_ Q
Federal Way -
PPLICATION NUMBER:
PPLICATION NUMBER: - -
**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.
A PROPERTY•. •
A
SITE ADDRESS: 34 SIS 4 P_ S. ASSESSOR'S TAX/PARCEL #: 7 S o 5 Q o z. -b
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT•- •
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
I— Se
PROJECT • w1u, -♦ ♦ t1
■ PROJECT INFORMATION
CONTRACTOR:
APPLICANT:
NAME: DAYTIME PHONE:
Fg%y, I+et,(f-k Sy54-evns. (zs3),�g (- b83�
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
1717 S, =T bF. lacort•sa� 984D�
NAME:
DAYTIME PHONE:
(z s3) ec-4 -
MAILING ADDRESS (STREET -ADDRESS; CITY, STATE, ZIP): I
EVENING PHONE:
(53<- a
k-
eez
( ) -
CITY OF FEDERAL WAY BUSINESS
FAX NUMBER:
JNUMBER
L o b
Q 3 0- Q b
(2-53) 65--q -
CONTRACTOR'S REGISTRATION NU E :
DATE:
=51
of card required)
D f- S
q:z'EXPIRATION
L(copy
1 !L �J
O /2-l
W'- r (2-S3) 854 -
MAILING ADDRESS (STREET ADDRESS; CITY, PrATE, ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): /,/Pc h _ Con ti'se[ Dr (Z,S7W) gam¢ - 92 -
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER AAPPLICANT ❑ CONTRACTOR I b t4k nr;In4 • t✓ 4 �• Cry
PR03ECT INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
❑ YES ❑ NO
PROPOSED VALUATION FOR IMPROVEMENTS: $ ODO
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE
❑ LAKEHAVEN ❑ HIGHLINE
❑ TACOMA ❑ PRIVATE (WELL)
❑ PRIVATE (SEPTIC)
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.
PLUS:
TARI F A
TOTAL VALUATION
FEE FACTOR
(1) $1.00 to $500.00
(1) $30.00
(2) $501.00 to $2,000.00
(2) $30.00 for the first $500.00 plus $4.00 for each additional $1017 or fraction thereof, to and including
$2,000.00
(3) $2,001.00 to $25,000.00
(3) $90.00 for the first $2,000.00 plus $18.00 for each additional $1.000.00 or fraction thereof, to and
including $25,000.00
(4) $25,001.00 to $50,000.00
(4) $504.00 for the first $25,000.00 plus $13.00 for each additional $1.000.00 or fraction thereof, to and
including $50,000.00
(5) $50,001.00 to $100,000.00
(5) $829.00 for the first $50,000.00 plus $9.00 for each additional $1000 00 or fraction thereof, to and
including $100,000.00
(6) $100,001.00 to $500,000.00
(6) $1,279.00 for the first $100,000.00 plus $7.00 for each additional $1.000.00 or fraction thereof, to and
including $500,000.00
(7) $500,001.00 to $1,000,000.00
(7) $4,079.00 for the fist $500,000.00 plus $6.00 for each additional $I.000.00or fraction thereof, to and
including $1,000,000.00
(8) $1,000,001.00 and up
(8) $7,079.00 for the first $1,000,000.00 plus $4.50 for each additional $1.000.00 or fraction thereof.
Bold number is the base fee for the specified increment
Itainxzed underfined number is the fee Per additional scecifled increment
a Nci x UUIIUI119 P—nm — wi Niau inview icc.
Add 25 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 **
0 BUILDING
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (1
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION: ,b //D
FEE FACTOR FROM TABLE A: Number: (o (a) Base Fee/ Z ?q
(b) Additional Increment Fee: Oct GyGY>
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5) 3 TJ z
N FIRE PREVENTION SYSTEM
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (6)
(a) Base Fee:
(b) Additional Increment Fee:
Estimated Plan Review Fee: (7)
0 PLUMBING
Base Fee Number of Fixtures
$26.00 + { X $9.00/fixture) _ (8) Estimated Permit Fee
Estimated Permit Fee
X .65 =
Miscellaneous Fixture Charge: (10)
Sub Total (Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)
(9) Estimated Plan Review Fee
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
■ PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
FIRST
HOOD(S)
WOODSTOVrE(S)
FIREPLACE INSERT(S)
SECOND
t MISC.
FURNACE(S)
THIRD
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
FOURTH
LAVATORY(S)
OTHER FLOORS (DESCRIBE)
WATER HEATER(S)
RAINWATER SYS.
VACUUM BREAKER(S)
DECK
SHOWER(S)
WASH MACHINE OUTLET
GARAGE
HOW MANY FLOORS?
WATER CLOSET(S)
MISC.
SUMP(S)
TOTAL:
Z AIR HANDLING UNIT(S)
BBQ(S)
BOILER(S)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAINS)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
❑ REPAIR ❑ TENANT IMPROVEMENT
MECHANICAL
LOT SIZE:
ZONING DESIGNATION:
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
FAN(S)
HOOD(S)
WOODSTOVrE(S)
FIREPLACE INSERT(S)
RANGE(S)
t MISC.
FURNACE(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
RAINWATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
SHOWER(S)
WASH MACHINE OUTLET
SINK(S)
WATER CLOSET(S)
MISC.
SUMP(S)
•BLOCK
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.
NAME/TITLE: DATE: iv
❑ PROPERTYOWNER (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
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.cityoffederalway.com