04-100424OtAof Federal Way
Conn n unity Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Mechanical Permit #:04 - 100424 - 00 - ME
Project Name: DENTAL OFFICE OF DR. JOHN HODGES
Inspection request line: 253.835.3050
Project Address: 33301 9THhSuite125 Parcel Number: 926501 0130
Project Description: Relocate/rep ace diffusers, install (2) return air grills and approximately 165' of exhaust ducting.
Owner
Applicant
Contractor
FWTPI, LLC
PACIFIC AIR CONTROL, INC
PACIFIC AIR CONTROL, INC
1201 PACIFIC AVE SUITE 1400
11812 N CREEK PARKWAY N SUITE 104
11812 N CREEK PARKWAY N SUITE 104
TACOMA WA 98402
BOTHELL WA 98011
BOTHELL WA 98011
(206) 682-6393
Mechanical Valuation..........................................6387 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Ducts 1
PERMIT EXPIRES August 3, 2004.
Permit issued on February 5, 2004
I hereby certify that the above information is correct and that the construction on the above described property ani
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington and
the Cityof Federal Way. -7 --
Owner or agentZ
:�'�1r'K ./� Date: S
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SECEIVED CONSTRUCTION PERMIT APPLICATION
CAY OF ��/ PPLICATION NUMBER: Q - 1 O Q _Z -
Federal Way FEB ® 5 2004[APPLICATION NUMBER:
(��PPLICATION NUMBER:
STY OF FEDERALWAY
**The foll�i "INQ'rtebinformation — Please print (in ink) or type**
a ✓Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
ERTY
O. INFORMATION
SITE ADDRESS: AV'X:: �ASSESSOR'S TAX/ PARCEL #: a& G/0/ 3 O —
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATT `CH SEPARATE DESCRIPTION IF LENGTHY):
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PROJECT INFORMATION
TYPE OF PROJECT (This application): O BUILDING O PLUMBING AECHANICAL O DEMOLITION
❑ ELECTRICAL O ENGINEERING O FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): (;Q� flood e- le �& d1���
PROJECT NAME: 722 . .JCI
PROPERTY OWNER: 'NAME:
MAI
CONTRACTOR:
APPLICANT:
NAME:
(STREET ADDRESS; CITY, STATE, ZIP):
DAYTIME P ONE:
DAYTIME PHONE:
Geb NZ& 3 9
MAILING ADDRVSS (STREET ADDRESS; CITY, STATE. ZIP):
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EVENING PHONE:
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CITY OF FEDERAL WAY BUSINESSSS LICENSE NUMBER:
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J / �1 FAX NUM ER:
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CONTRACTOR'S REGISTRATION NUMBER:
-'
BXPIRA DATED:
(cDpyofmro reqwred)
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✓
DAYTIMEPHjr7 /i, ��� i
DA T I Ag I
MAILING ADDR (STREET ADDRESS; CITY, STATE, ZIP):
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�EV�E/NING
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE):\
i FAX NUMBER: '
?VQj
E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: O PROPERTY OWNER O APPLICANT TRACTOR
DETAILED BUILDING INFARMATTC
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATIO Q
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMNTS: il; v
SPRINKLERED BUILDING? ❑ YES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIR
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
O LAKEHAVEN ❑ HIGHLINE
0 LAKEHAVEN ❑ HIGHLINE
O TACOMA ❑ PRIVATE (WELL)
❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ f
■ 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 UNIT(S) EVAPORATIV COOLER(S) LOG
(S) LOS) REFRIG. SYSTEMS)
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) SINK(S) WATER CLOSET(S) MISC. ( )
INTERCEPTORS) SUMP(S)
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 tgthe city as apart of tfis application.
❑ PROPERTY OWNER ❑ APPLICANT ❑ tONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.citvoffederalway.com
Construction Permit
****4***PLEASE NOTE: ALL FEES MUST BE VERIFIED
CHECKS FOR INCORRECT AMOUNT
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 ad Wona/S100.00or
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 S18,00 for each additional
$1.00.00 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 additional51.000
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 S9.00foreach ad"nal51.00000or
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
$1.000ob 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 55.017 for each additional
S1.O X10Y! or fraction thereof, to and
including $1,000,000.00
(8) 51,000,001.00 and up
(8) $7,079.00 for the first $1,000,000.00 plus 54.50 for each
additional S1.000, or fraction thereof.
Bold number Is the base fee for the specified Increment
1Yalicfred undetfined number is the fee ver addltfonal snedl
ed maement
rwu 65 percenr a me base buueing permit fee for pian review Tee.
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, 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)
(COMMERCIAL ONLY)
PROPOSED VALUATION:
■ BUILDING
(a) Base Fee:
(b) Additional Increment Fee:
,30706
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:
PLUMBING
Base Fee Number of FoUes
$26.00+( X $9.00/fixture} _ (8) Estimated Permit Fee
Estimated Permit Fee
.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