03-105309Ti
City 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: TEODOROVIC
Project Address: 508 SW 331ST St
Project Description: Remove and replace gas furnace
Mechanical Permit #:03 -105309 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 729801 0040
Owner
Applicant
Contractor
Nedeljko Teodorovic & Maria Teodorovic
PERFORMANCE HEATING & A/C INC
PERFORMANCE HEATING & A/C INC
508 SW 331 ST ST
7649 S 180TH ST
7649 S 180TH ST
FEDERAL WAY WA
KENT WA 98032
KENT WA 98032
98023-6162
1
1 (425) 251-0356
Mechanical Valuation..........................................2300 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
12-%105 Irz-f , filW �o%Ic41/ ��,eoven-1
I
CONSTRUCTION PERMIT APPLICATION
CITY OF ter- RECEIVED PPLICATION NUMBER:OZ - _ ,30 -
Federal Way kPPLICATION NUMBER: - -
-- ------ --
DEC 0 3 2003 PLICATION NUMBER: - -
*'The Qjlpiopppfg��}� W•A)fmation — Please print (in ink) or type**
Please note: Electrical, Fire Prrev�en-tion�iSt�Itis and Engineering permits may require a separate application.
c j PROPERTYp O
SITE ADDRESS: S0� -5� - 31, s1 SI - ASSESSOR'S TAX/PARCEL #: 7 Z / O m I
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): O BUILDING o PLUMBING MECHANICAL ❑ DEMOLITION
O ELECTRICAL o ENGINEERING o FIRE PREEVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): C� aS c ov-- J5r13 gs Fy✓rtdr(4__
PROJECT NAME: T'fo lD6fz 0 y( C )`'cS I� c'1N C
PROPERTY OWNER:
CONTRACTOR:
DAY! IML PHONL:
MAILING ADDRESS (STREET ADDRESS; CITY, STf.TE, ZIP):
i s68�3i sf _ F��Qr�I wR 780 2- 3
NAME'DAYTIME
N�
PHONE:
! (Vir) 2_ l - 03r!
1 MAILING ADDRESS (STREET ADDRESS; CIT f, STATE. ZIP):
I ?o t S, l XQ ktA r w 9Sd3 Z
EVENING PHONE!
! (qtr ) 2 r/ -03 r6
CiIY OF FEDERAL WAY BUSINESS LICENSE NUMBER:!
FAX NUMBER:
-oo �L (�zr>2s1 -u2yo
CONTRACTOR'S REGISTRATION NUMBER:
1'
I EXPIRATION DATE:
t/ / 2q / s
(ropy of card required)
a 1
APPLICANT: NAME: DAYTIME PHONE:
7-60
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): i EVENING PHONE:
RELATIONSHIP TO PROJECT: ! FAX NUMBER:
l ❑ ARCHITECT O TENANT peOTHER ( DESCRIBE):
I i
E-MAIL ADDRESS: I
I
CONTACT PERSON FOR THIS PROJECT: ❑PROPERTY OWNER o APPLICANT ❑CONTRACTOR �
DETAILED BUILDING• •
EXISTING USE: EXISTING BUILDING ASSESSED/ APPRAISED VALUATION
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: O YES o NO
WATER SERVICE PROVIDER: o LAKEHAVEN O HIGHLINE o TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE o PRIVATE (SEPTIC)
0
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROTECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNITS) EVAPORATIVE COOLER(S) GAS LOGS) 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: o ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC o GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINKS) WATER CLOSET(S) MISC. ( )
INTERCEPTORS) SUMP(S)
]TSCLOTMFR/STGNATHRF RLC
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: J/,� ` -!�— SJ ' 'tr1- DATE: /3/�-3
o PROPERTY OWNER o APPLICANT K CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-6661-4129
www.cttvoffederalway.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 59.00 for each acUftnal5100.00or
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 578.00 for each addtfonal
$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 addTtional51.000.00
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
51.01010.00 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 S7.00 for each addflfonal
51.000 00 or fraction thereof, to and
including $500,000.00
(7) $500,001.00 to $1,000,000.00
(2) $4,079.00 for the fist $500,000.00 plus SS.00 for each acAfWonal
S1.U00 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 $1.0010.00 or fraction thereof.
Bold number is the base fee for the specified Increment
ID11cfred. underflned number Is the lee Per addfdonafmycilTed
fnaement
Aad 65 percent or the base building permit fee for plan review fee.
Add 2S percent of the base mechanical pertntt fee for mechanical plan review fee.
Add 15 percent of the base building permit fee for Fire District *39 surcharge, commercial only.
Add $4.SO 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 Pian Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALU • : 2 3 (3-0 r1�
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)
■ BUILDING
(a) Base Fee:
(b) Additional Increment Fee:
(a) Base Fee: /76- G d
(b) Additional Increment Fee:
■ FIRE PREVENTION SYSTEM
(a) Base Fee:
(b) Additional Increment Fee:
PLUMBING
Base Fee Number of Ftxhues
$26.00 +(
X $9.00/fixture) _ (8) Estimated Permit Fee
Fstimated Permit Fee
X .65 =
Miscellaneous Fixture Charge: (10)
Sub Total (Page one): Line(s)(1)+(2)+(3)+(4)+(S)+(6)+(7)+(8)+(9)+(10) = (11)
(9) Estimated Plan Review Fee