03-101573r
f
City Federal Way
Community Development Services Mechanical Permit #: 03 - 101573 - 00 - ME
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: WHITLEY VJv
Project Address: 30057 10TAW Parcel Number: 515320 0416
Project Description: Gas to gas furnace changeout
Owner
Applicant
Contractor
James M Whitley
FURNACE DOCTORS
FURNACE DOCTORS
30057 10TH AVE SW
3802 SW 177TH SW
3802 SW 177TH SW
FEDERAL WAY WA
LYNNWOOD WA 98037
LYNNWOOD WA 98037
98023-8207
(206) 856-6445
Mechanical Valuation..........................................550 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
I hereby certify that the abo ation is ect and ththe construction on the above described property and
the occupancy and th e will be in c ce with the 1 s, rules and regulations o"Statef on and
the City of Feder ay.
Owner or e Date
Mechanical rough -in:
Gas pipe:
FINAL MECHANICAL: L%/`
Date
,:�A"_�5
ate
4
4%
RECEIVED CONSTRUCTION PERMIT APPLICATION
CITY OF �.� PPLICATION NUMBER:
Federal Way APR 2 2 2003 PPLICATION NUMBER: — _ - _ _ - _ _
CITY OF FEDERAL WAY. PPLICATION NUMBER: _ — - — — — — — — - — —
**The fA"i*a0fE -•fjd information- Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY INFORMATION
SITE ADDRESS: �JL/LJ� / !� tl'%S. br ASSESSOR'S TAX/PARCEL #: _ _ _ — _ _ -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PRO3ECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING o PLUMBING '�1ECHANICAL o DEMOLITION
o ELECTRICAL ❑ ENGINEERING o\FIRE PREVENTION SYSTEM r
PROJECT DESCRIPTION (Provide detailed description): L l iffla e- ,A—
PROJECT NAME:
PEOPLE•• •
PROPERTY OWNER: NAME' r DAYTIME PHONE:
I �
MAILING ADDRESS (STREET AD ESS; CITY, STA , ZIP): e
10
CONTRACTOR: NAME: DAYTIME PHONE:
a C- } - _
MAILING ADDRESS (STREET ADDRESS; CITY, TE. Z1P): a KR I EVENING PH ONE'
T I _
CITY OF FEDERAL WAY BUSINESS LICENSE NUMB - FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: )
_� (ropy of card required) EXPI� N /DATE:1/
APPLICANT:iAYTIME PHONE*
1
ti r 7r
MAILING ADDRESS (STREET ADDRESS; CITY, sTATe. ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: ; FAX NUMBER:
l o ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE):
� E -MAP ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ( /CONTRACTOR I
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
EXISTING BUILDING ASSESSED/ APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: o YES
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
❑ NO
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
SHOWER(S)
GAS PIPE OUTLET(S)
SINKS)
FIRST
SUMP(S)
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate n%mber of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S)
BBO(S) FAN(S)
BOILERS) FIREPLACEINSERT(S)
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S)
PLUMBING
BATHTUB(S)
LAVATORY(S)
DISHWASHERS)
RAIN WATER SYS.
DRINKING FOUNTAIN(S)
SHOWER(S)
GAS PIPE OUTLET(S)
SINKS)
INTERCEPTORS)
SUMP(S)
GAS LOG(S) REFRIG. SYSTEM(S)
HOOD(S) WOODSTOVE(S)
RANGE(S) MISC. ( )
HEAT SOURCE: ❑ ELECTRIC ❑ GAS
URINAL(S) WATER HEATER(S)
VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC.
]iSCLATMER/SIGNATURE 13LC
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 Fede y to any claim (including costs, expenses, and attorneys' fees incurred in the
Investig
ation claim), w ' may b made by any person, including the undersigned, and filed against the City of
Federare su d m ses out of a reliance of the city, including its officers and empl ees, upon accuracy
of the o s a part of is ap 'cation.
NAMEDATE:
❑ PROAPP CANT VCONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOX 9718 - FEDERAL WAY, WA 98063-9718 - 253-661-4000 • FAX: 253-661-4129
www.cttvoffederalway.c—
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 54.00 for each additional
$100, 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 $16,00 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 $S0,000.00
(5) $50,001.00 to $100,000.00
(5) $829.00 for the first $50,000.00 plus $9.00 for each additional
$1.000.00 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 57.00 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 56.00 for each
addWonal $1,000.ob 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 $4.50 for each
additional51.000.LYJor fraction thereof.
Bold number is the base fee for the specified Increment
Italldred underflned number Is the fee per add/donal snec1ffe
f Increment
Add 65 percent of the base building permit 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)
(OOMMERCIAL ONLY)
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
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)
■ BUILDING -- _
(a) Base Fee:
(b) Additional Increment Fee:
(a) Base Fee:
(b) Additional Increment Fee:
■ FIRE PREVENTION SYSTEM
(a) Base Fee:
(b) Additional Increment Fee:
PLUMBING
Base Fee Number of Fbftres
$26.00+( X $9.00/fixture) _ (8) Estimated Permit Fee
Estimated Permit Fee
X .65 =
Miscellaneous Fixture Charge: (10)
Sub Total (Paye one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)
(9) Estimated Plan Review Fee