03-104400City 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: BIG LOTS
Project Address: 1211 S 320TH cj'i
Project Description: Install ductwork for HVAC units.
Mechanical Permit #:03 -104400 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 150050 0030
Owner
Applicant
Contractor
1560 INVESTORS LLC
EVERGREEN REFRIGERATION INC
EVERGREEN REFRIGERATION INC
200 S BROAD ST #6
727 S KENYON
727 S KENYON
SEATTLE WA 98108
SEATTLE WA 98108
Mechanical Valuation .......................................... 90001
Over the Counter Permit.
.( -206)•763-1744 ........ No
MechanicalFixtures
PERMIT EXPIRES March 31, 2004.
Permit issued on October 3, 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 accor wt the laws, rules and regulations of the State of Washington and
the City of Federal Way. ___---
Owner or agent: Date: zc'pa'
l 4GT SW-G.,t,j /< A l / / 0 - l v • c, \\
ll%ec' ,, �, /L / (we-" c'-�
IV
CONSTRUCTION PERMIT APPLICATtON
-.
ary of PPLICATION NUMBER:
Federal Way PPLICATION NUMBER:
PLICATION NUMBER: —�_ '_ff__
—The following is required information - Please print (in ink) or type .03 �� aq Too -ptj��
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY •.•
SITE ADDRESS: 1� 6' J _ s?X,J� l 1�. ASSESSOR'S TAX/PARCEL #: �+O 0 - C�o Q
LEGAL DESCRIPTIQN OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PRO3ECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING ❑ PLUMBING MECHANICAL o DEMOLITION
O ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): 4 Y A o h ,-�S
PROJECT NAME:
CONTRACTOR:
NAME:
Ic��
}f
CQ l 1
D YT/IM�E PHONE:
MAILING ADDRESSWREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
i
CITY OF FEDERAL WAY BUSINESS LICENSE UMBER:
) _o L
FAX NUMBER:
i (k6 )7 3
- ?
CONTRACTORS REGISTRATION NUMBER:
(ropy of card required) V (' ,,T� Y t 07
— — —
EXPIRATION DATE:
i • / l � �
r1
l �(j
APPLICANT: I NAME:
�ja�y. �1 '/. `�
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
RELATIONSHIP TO PROJECT:
o ARCHITECT ❑ TENANT (OTHER ( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER o APPLICANT ❑ CONTRACTOR
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
o YES o NO
DAYTIME PHONE: i
EVENING PHONE:
FAX NUMBER:
) i
E-MAIL ADDRESS: 1
PROPOSED VALUATION FOR IMPROVEMENTS:
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: O YES o NO
❑ LAKEHAVEN ❑ HIGHLINE
❑ LAKEHAVEN ❑ HIGHLINE
❑ TACOMA ❑ PRIVATE (WELL)
❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNITS)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S)
FAN(S)
FIREPLACEINSERT(S)
FURNACE(S)
GAS PIPE OUTLET(S)
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
Value of Mechanical Work:
GAS LOG(S)
HOOD(S)
RANGE(S)
o
REFRIG. SYSTEM(S)
WOODSTOVE(S)
MISC. ( )
HEAT SOURCE: ❑ ELECTRIC ❑ GAS
URINAL(S) WATER HEATER(S)
VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC. ( )
DTSCLATMER/STGNATl1RE 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: •.� ! r ✓' DATE:
❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 2S3-661-4000 FAX: 253-661-4129
www. y federalway.com
r . '%
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:
rr1l011W.
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 additional S100,00
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 518.00 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 $75,000.00 plus IL100 for each additional51.000
Gb 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 5200 for each additional
sI 010000 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 $ZOO for each addtnal
S1000Ori or fraction thereof, to and
including $500,000.00
(>) 5500,001.00 to $1,000,000.00
(7) 54,079.00 for the fist $500,000.00 plus K OO for each additional
SI 0a0 Cb 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 IL50 for each
addi8ona/SS 0710 [b or fraction thereof.
Sold number is the base fee for the Specified increment
.AAG
IWAnfred underflned numberls the lee Per adddona1
ed fnc ement
—u w ycrtxin u Ulu base Wilding permit fee for plan review fee.
Add 2S percent of the base mechanical permit fee for mechanical plan review fee.
Add 1S 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: (1)
Estimated Pian Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION: Q c>o
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
PROPOSED VALUATION:
■ BUILDING
(a) Base Fee:
(b) Additional Increment Fee:
(a) Base Fee:
(b) Additional Increment Fee:
■ FIRE PREVENTION SYSTEM
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
Base Fee Number of Fixtures
$26.00 +(
X $9.00/fixture} _ (8) Estimated Permit Fee
Estimated Pernik 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
Detach And Display Certificate
EVERGREENx' REFIGERATIfJN INCIN
.'.
7 2 7 $_.NYDN ST��
SEA�'TLELWA 9,8108
Signature
Issued by DEPARTNIENT�9„LA 161 ANDNIDUSTRIES