03-103043City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: PIERCE
Project Address: 112 SW 307TH P l
Project Description: Remove/replace gas furnace
Mechanical Permit #:03 -103043 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 556000 1130
Owner
Applicant
Contractor
Lawrence R Pierce & Cynthia L Pierce
ENERGY RECLAIM
ENERGY RECLAIM
30402 8TH AVE SW
ENERGY RECLAIM
ENERGY RECLAIM
FEDERAL WAY WA
PO BOX 1726
PO BOX 1726
98023-8224
GIG HARBOR WA 98335
1 (253) 853-4112
Mechanical Valuation..........................................3900
Furnaces
Over the Counter Pennit......................................Yes
I hereby certify thattabeormation is correct d that the construction on the above described property and
the occupancy and tin acco dance the laws, rules and regulations of the State of /ashmton and
the City of Federal
Owner or agent: Date: �
zN1,6,
CONSTRUCTION PERMIT APPLICATION
CITY Of
PPLICATION NUMBER: - IQ —-
Federal Way JUL2 1 t "'hid PPLICATION NUMBER: - -
C1 1 -Y C7;= r r PPLICATION NUMBER:
—The fo ' c �c�afred information - Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
�J -PROPERTY• •
Sw
SITE ADDRESS: 11.13(0 ` Tµ ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT•
•
TYPE OF PROJECT (This application): o BUILDING
o PLUMBING
'MECHANICAL o DEMOLITION
o ELECTRICAL
o ENGINEERING
❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): K
:AA-Qv-e
<f i S ce
PROJECT NAME:
PEOPLE•
•
PROPERTY OWNER: NAME:a
; DAYTIME PHONE'
P e2ce
)
-
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
t 7 � 72
-STI
CONTRACTOR:NAME:
i DAYTIME PHONE:
MAILING ADDRESS (STREtT ADDRESS; CITY, STATE. ZIP):
Pd X 172- . G /q
!�{A�b�'Q�f�t�
EVENING PHONE:
(ZS3) ZZ�i
CITY OF FEDERAL WAY BUSINESS LICENSE N MBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
(� of car, mqu, ed) 6xE R G R
EXPIRATION DATE:
APPLICANT: NAME: f DAYTIME PHONE:
MAILING ADDRESS (SMEET ADDRESS; CITY, STATE, ZIP): EVENING PHONE
I
RELATIONSHIP TO PRO)ECT: nn i FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE):�plu�lp✓k- OI\ )
a
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR I
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
❑ YES
■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ ?
PROPOSED VALUATION FOR IMPROVEMENTS: $ �7
❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE
❑ LAKEHAVEN ❑ HIGHLINE
❑ TACOMA ❑ PRIVATE (WELL)
❑ PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE:
■ PROJECT 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)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
MECHANICAL
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
17ILIIN-I( {e
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
URINAL(S)
WATER HEATER(S)
VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC. ( )
]TCCI_ATMFR /CT[,NATIIRF RIC
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 thwc,"t,
�as(�apaart of this application.
NAME/TITLE: �`C ul e DATE: 7/Z 3
43
❑ PROPERTY OWNER ❑ APPLICANT I&ONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.citvofederalway.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.
PLUS:
TABLE 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 S4.00 for each additions/
$100 00 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 S1602for each add, tional51,00000or
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 512012 for each additions/SI
000 A2 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 S202 far each additional51000
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 S OQ for each
additional S1 Oo0 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 K02 far eadr additional
SI 00000 or 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 S4.50 for each
additional 11,000or fraction thereof.
Bold number Is the base fee for the specified Increment
RaAcked undefflned number is the fee per pc(010onalsyedfled
In meet
pe Cee . " u is Wa vunuuig pennft fee for plan review fee.
Add 25 percent of the base mechanical permit fee for mechanical plan review fee.
Add 15 percent of the base building permit fee for FIre 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:
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION:
■ BUILDING
(a) Base Fee:
(b) Additional Increment Fee:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee:
Estimated Plan Review Fee: (7)
■ FIRE PREVENTION SYSTEM
(a) Base Fee:
(b) Additional Increment Fee:
Base Fee--- 0 EJ 'k 1161:) 4
Number of Fixtures
$26.00+( X $9.00/fixture} _ (8) Estimated Permit Fee
Estimated Permit Fee
.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