04-100493City ofFederalWay
Community
Development Services Mechanical Permit #:04 - 100493 - 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: SHERIDAN
Project Address: 3925 SW 316TH s i Parcel Number: 873198 2160
Project Description: Replace gas furnace.
Owner
Applicant
Contractor
Gladys Sharon Sheridan
ROSSOE ENERGY SYSTEMS INC
ROSSOE ENERGY SYSTEMS INC
3925 SW 316TH ST
9367 RAINIER AVE S
9367 RAINIER AVE S
FEDERAL WAY WA
SEATTLE WA 98118
SEATTLE WA 98118
98023-2151
(206) 725-7555
Mechanical Valuation..........................................4453 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quantity Description lQuantityl I Description Quanti
Furnaces
PERMIT EXPIRES August 10, 2004.
Permit issued on February 12, 2004
I hereby certify that the above inforrnation 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: See ADDIkatiol_ Date: �2
ECIVED BY
CaaR
`� 1ffYDEVEEOP ENT EPARTME ONSTRUCTION PERMIT APPLICATION
CITY OF
FEB1 1 2004 PPIICATION NUMBER: 6 _ - _ _O_ _ _ -
Federal Way PPLICATION NUMBER: _ _ - _ _ _ _ _ _ - _ _
PPLICATION NUMBER: - -
•'The following is required 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: �25 d V � _5` aZ� ASSESSOR'S TAX/PARCEL #:�� -zp_
LT21t
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT•• •
TYPE OF PROJECT (This application): o BUILDING o PLUMBING AMECHANICAL o DEMOLITION
o ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
PROJECT NAME: PYl(7(l:
PEOPLE•• •
PROPERTYOWNER: NAME: DAYTIME PHONE:
��n2.rr�c� �ir-�e�c=id�a-x� i (Z53�38 -SSS
M�G ADDRESS (S ADDRESS; ATE 1
CONTRACTOR: NAME: •G, •c7 S `` I DAYTIME PHONE:
i MAILING ADDRESS (STREET ADDRESS; CI1Y,IP): EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBE ,,.1 )i FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:n I EXPIRATION DATE:
Q
(copy of card required) 5 Q� S\ L\ Z
APPLICANT: NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: FAX NUMBER:
o ARCHITECT ❑ TENANT o OTHER ( DESCRIBE):�1
j E-MAIL ADDRESb:
I
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR I
EXISTING USE:
PROPOSED USE:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED VALUATION FOR IMPROVEMENTS: $ 4�53
SPRINKLERED BUILDING? o YES c1MO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: O YES ❑ NO
WATER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: O LAKEHAVEN o HIGHLINE o 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 Value of Mechanical Work: $
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. [ 1
COMPRESSOR(S) t FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHERS) 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.
INTERCEPTORS) SUMP(S)
']TSr1 ATMFR/STGNATIIRF 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 ac part
�of this application.
NAME/TITLE: DATE: "
❑ PROPERTY OWNER ❑ APPLICANTCONTRACTOR
I A'
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 FAX: 253-661-4129
4.-,
www.citvof%deralway.00m
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 $4.00 foreach addition/
5100.00 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 SIAM fol 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 513.00 for each additional
S .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 59.00 for each addVona/!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 additnal
SLOW.0n 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 S6.00 for eadr adddionl
SI.000 00 or fraction thereof, to and
kcluding $1,000,000.00
(8) $1,000,001.00 and up
(8) $7,079.00 for the first $1,000,000.00 plus S4.SOfor eadb
addition/S1.000.QQor fraction thereof,
Bold number Is the base fee for the specified Increment
AM&Yzed undedAwd number Is dire fee aerodd/dona/ wedfled
/narment
rwu w petcxta un We od5e ounxinntg permit fee for pian 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)
(COMMERCIAL ONLY)
■ BUILDING
(a) Base Fee:
(b) Additional Increment Fee:
MECHANICAL
PROPOSED VALUATION: �3
FEE FACTORt-ROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (4)
—50
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:
N PLUMBING
Base Fee Number of Fixhues
$26.00+( X $9.00/fixture) _ (8) Estimated Permit Fee
Estimated Permit nee
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