03-105449City 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: MITCHELL
Project Address: 5101 SW 316TH
Project Description: Replacing an existing gas furnace
Mechanical Permit #:03 -105449 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 102103 9016
Owner
Applicant
Contractor
Joseph W Mitchell
PERFORMANCE HEATING & A/C INC
PERFORMANCE HEATING & A/C INC
5101 SW 316TH PL
7649 S 180TH ST
7649 S 180TH ST
FEDERAL WAY WA
KENT WA 98032
KENT WA 98032
98023-2037
(425)251-0356
Mechanical Valuation..........................................3100 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quantity Description Quanti Description Quanti
Furnaces 1
PERMIT EXPIRES June 13, 2004.
Permit issued on December 16, 2003
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 Washingtonand
the City of Federal Way.
Owner or agent: �2 Date: (2--16'
76 �;7 2 r
RECEIVED CONSTRUCTION P MIT APPU TION
CITY OF '.� PPLICATION NUMBER: _ _ - — - — _�
Federal Way DEC I § 2003 PPLICATION NUMBER:
PLICATION NUMBER: - -
CITY OF FEDERAL WAY .
"The followiBw jkDffli8rERE0ormatlon — Please print (in ink) or type*'
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
/ e PROPERTY• • /
SITE ADDRESS: S/G I SW 31�0P� - ASSESSOR'S TAX/PARCEL it: l o Z f Q - 9 6 b
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PRO]ECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING o PLUMBING ,'MECHANICAL o DEMOLITION
❑ ELECTRICAL o ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): ge-pl k c— f�c(S'%U►!5 6 4 S / v rnk'C'<—
PROJECT NAME
IMPEOPLEINFO •
PROPERTY OWNER: NAME: DAYTIME PHONE:
I•��� S3% 5718 _
t
CONTRACTOR:
APPLICANT:
�02
x0.1w %U� �'3
SJbJ -SW 331(o.T- r1- wa
NAME:
DAYTIME PHONE:
'.
MAILING DRESS (STREET ADDRESS; CITY, STATE. ZIP): Q Pj
76YI s- /761# ki/� r 1� l 0X32
EVENING PHONE:
; (�('�-� > 2S1 Q3SG
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
o_oo 0 Z
FAX NUMBER:
- 60 -BL 1 (Y2'- ) 25-( - 6z P
CONTRACTOR'S REGISTRATION NUMBER:EXPIRATION
elF le F -6 ��
DATE:
(a)py of card required)
NAME: DAYTIME PHONE:
6w- rti IC re, rs< (y2f )-2-s-(
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP . EVENING PHONE:
A,r 70f S l KrJ f j- kl n f ",P- QPa.3 t (42r) 2Fi -'03.r6
RELATIONSHIP TO PROJECT: A j FAX NUMBER:
❑ ARCHITECT o TENANT OTHER ( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT M -CONTRACTOR
EXISTING USE:
PROPOSED USE:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS:
E-MAIL ADDRESS:
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES o NO
WATER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE ❑ TACOMA ❑ PRIVATE (WE(L)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE G PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY** ,
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE:
.. ■ PR03ECT 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 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)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINKS) WATER CLOSET(S) MISC. ( )
INTERCEPTOR(S) SUMP(S)
')TSCLOTMER/ST[;NATIIRF 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 perforin 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: /z/1 / A3
❑ PROPERTY OWNER ❑ APPLICANT ['CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.cKyoffederalway.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:
TAB[ F A
TOTAL VALUATION
pe,—,,t
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 $1122 for each addition/
SIQO 0r1 or fraction thereof, to and inducting
$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 addittonat
$1.000. 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 SI?00 for each addition,$100000or
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 19.00 for ead4 addtttofw1
S10W 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 SZOO for eadh additional
11,000.00 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 56.00 for each add'
inna/ 1000 Qb or (radion 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. 0for eadr
addibbon/S1 QW.00 or fraction thereof.
Bold number Is the base fee for the specified Increment
AAA LC _ __—__
Ila/Idzed undeif/ned number Is the fee per fddlffolyal s..adfied
/narement
VJ " um base uuaumg perms nee for plan review fee.
Add 2S 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, commerdal 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
(a) Base Fee:
(b) Additional Increment Fee:
0 MECHANICAL
PROPOSED VALUATION: 1 3/ d O
FEE FACTOR FROM TABLE A: Number: -3 (a) Base Fee: / Q 0 6
(b) Additional Increment Fee:
Estimated Permit Fee: (4) Y-6 06
Estimated Plan Review Fee: (5)
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
■ FIRE PREVENTION SYSTEM
(a) Base Fee:
(b) Additional Increment Fee:
PLUMBING
Base Fee Number of Fixtures
$26.00+( X $9.00/fixture) _ (8) Estimated Permittee
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 Rgview Fee