03-102589,A
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: CROXDALE RESIDENCE
Project Address: 454 SW 297TH $f'
Project Description: Install of 3.5 ton A/C
Mechanical Permit #:03 -102589 - 00 - MF
Inspection request line: 253.835.3050
Parcel Number: 720520 0160
Owner
Applicant
Contractor
LEYTON CROXDALE
PERFORMANCE HEATING & A/C INC
PERFORMANCE HEATING & A/C INC
454 S 297TH ST
7649 S 180TH ST
7649 S 180TH ST
FEDERAL WAY WA 98032
KENT WA 98032
KENT WA 98032
(425)251-0356
Mechanical Valuation..........................................5100 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: 5;9� a � Date: G 2 3 - o2
RECEIVE®
CITY OF �V
Federal WayjuN 2 4 2003
CONSTRUCTION PERMIT APPLICATION
PPLICATION NUMBER:-
PPLICATION NUMBER:PLICATION NUMBER: - -
CITY OF
* "{c
PT. i�$red information —Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS: q,5 Sw 29771
97� S/ ASSESSOR'S TAX/PARCEL #: Z D
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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 EENNGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): �� `� 3 l U/✓ �C—
PROJECT NAME: C 1Z O X 1� A L.E- le.�ll���
PEOPLE•• •
PROPERTYOWNER: NAME:
LC- - Ta,'--' o X Dr9L-E-
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
CONTRACTOR: NAME:
1'9C11 --V71*1/C19E
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
f 76g? So i Flt, f- L/T
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
L 9-
- s_
CONTRACTORS REGISTRATION NUMBER:
(com of oro reouired)
APPLICANT: NAME:
803
D (1 6)
M
DAYTIME PHONE:
(yah )zs l
- o3s�6
EVENING PHONE:
(y2f-12)-(
- oI?sbl
FAX NUMBER:
- N 2 i (yZf )zs (
- 0
j EXPIRATION DATE:
O i I b 4/ / 2_
l b f
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): (EVENING PHONE:
I ` )
RELATIONSHIP TO PROJECT: i FAX NUMBER:
o ARCHITECT o TENANT ❑ OTHER ( DESCRIBE): ( ) -
i E-MAIL ADDRESS: _
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER o APPLICANT ❑ CONTRACTOR
]FTATLED BUILDING INFCIRMATIC
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $r:5--1
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: O YES ONO
WATER SERVICE PROVIDER: O LAKEHAVEN ❑ HIGHLINE O TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ 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:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNrr(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: o ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHERS) 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)
BLOCKDISCLAIM ER/SIG NATURE
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: �-�—
o PROPERTY OWNER o APPLICANT XG NTRACTOR
DATE:
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 •253- 661-4000 • FAX: 253-661-4129
www.ODIpMeralway.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 0.00 for each adJ1tions1$100.A1
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 $18.010 for each additional
51.000, 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 513.00 for each addtnal
$1,000.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 S9.010 for eadi additional
$1.000.Obor 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 $7.00 for each additional
SI.000.00or 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 $6.00 for each additional
SLOW AO 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 54.50 for ead�
additional S1.0W Q0 or fraction thereof.
Bold number Is the base fee for the specified Increment
MfibFzed. undettJned number Is the lee per addldonafam~
Jnorment
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 **
■ BUILDING
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION: � I ® O
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: (6)
Estimated Plan Review Fee: (7)
■ FIRE PREVENTION SYSTEM
(a) Base Fee:
(b) Additional Increment Fee:
ease Fee Number of Fo ures
------
$26.00+( X $9.00/fixture} _ (8) Estimated Permit Fee
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 Review Fee