03-101258City of Federal Way
Conununity Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661-4129
Project Name: CHALKLEY
Project Address: 1416 SW 296TH 5r
Mechanical Permit #:03 -101258 - 00 - ME
Project Description: Install replacement furnace, 90% gas.
Inspection request line: 253.835.3050
Parcel Number: 062104 9032
Owner
Applicant
Contractor
Peter J Chalkley
GATEWAY HEATING & AIR CONDITIO
GATEWAY HEATING & AIR CONDITIO
1416 SW 296TH ST
3802 AUBURN WAY N
3802 AUBURN WAY N
FEDERAL WAY WA
AUBURN WA 98002
AUBURN WA 98002
98023-3411
(253)931-0610
PERMIT EXPIRES September 28, 2003.
Permit issued on April 1, 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 accordance with the laws, rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: Date: l 3
41,r --A, � C) �- 6 — , 2
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CONSTRUCTION PERMIT APPLICATION
PPLICATION NUMBER:
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.
SITE ADDRESS: f /16 (.�� �C7C�? 1 �' f '" ASSESSOR'S TAX/PARCEL #:(a 7'
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING 'MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING El FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): V
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
CONTACT PERSON
EXISTING USE:
PROPOSED USE:
- ■ PEOPLE INFORMATION
NAME: t DAYTIME PHONE:
)Q -
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): -
c OJS A()
NAME:
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DAYTIME PHONE:
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MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): , Gs�L
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
a - Lost
FAX NUMBER:q
(20)ppq-
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CONTRACTOR'S REGISTRATION NUMBER:
(copy of card required) �5 / G l� O
EXPIRATTIION DATE:
/�{ / D/
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NAME:
DAYTIME PHONE:
c�s3) 9 -
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MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
c
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑ TENANT OTHER ( DESCRIBE):�4^d�jTT(J
FAX NUMBER:
-
-OR THIS PROJECT: ❑ PROPERTY OWNER �PPLICANT CONTRACTOR
E-MAIL ADDRESS: -
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $� �l__.l�> -J
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
11 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTION ONLY --
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE: $
■ PR03EIM FLOOR AREAS I
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
FIRST
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILER(S)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
WPIFIMIRW
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEMS)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERT(S) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
URINALS)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
-%TSCLATMER/RTGNATURE BLC
WATER HEATER(S)
❑ ELECTRIC ❑ GAS
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 s pplied to the ity-s a. part of this application.
NAME/TITLE: ,_ J— J �VLUOA�J, ATE: /v\
❑ PROPERTY OWNER APPLICANT AkONT4CTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
Comm[ INITY rfFVF1 OPMENT SERVICES - 33S30 FIRST WAY SOUTH - P.O. BOX 9718 - FEDERAL WAY. WA 98063-9718 - 253-661-4000 - FAX: 291-661-4129
I
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.
TABLE A
TOTAL VALUATION
FEE FACTOR
(1) $1.00 to $500.00
(1) $24.25
(2) $S01.00 to $2,000.00
(2) $24.25 for the first $500.00 plus 53.17foreach addNnnal5100.00or fraction thereof, to and including $2,000.00
(3) $2,001.00 to $25,000.00
(3) $71.46 for the first $2,000.00 plus $15.00 for each additional
SI.000.00or fraction thereof, to and including
S2S,0W.G0
(4) $25,001.00 to $50,000.00
(4) $403.61 for the first $25,000.00 plus 510.81 for each additional
$1.000.00 or fraction thereof, to and including
$50,000.00.
(5) $50,001.00 to $100,000.00
(5) $664.35 for the first $50,000.00 plus $750 for each additional
$1.000.00 or fraction thereof, to and including
$100,000.00.
(6) $100,001.00 to $500,000.00
(6) $1,02S.S5 for the first $100,000.00 plus 56.00 for each
additional St.000.00or fraction thereof, to and including
$500,000.00
(7) $500,001.00 to $1,000,000.00
(7) $3,337.23 for the fist $500,000.00 plus $509 for each additional
S1.000. or fraction thereof, to and including
$1,000,000.00.
(8) $1,000,001.00 and up
(8) $5,788.23 for the first $1,000,000.00 plus $3.91 for each
additional $1.000. or fraction thereof.
Bold number is the base fee for the specified increment
Italicized, underlined number is the fee per additional specified
increment
PLUS: Add 65 percent of the base building permit fee for plan review tee.
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: (1
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (4
Estimated Plan Review Fee:
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (6
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:
Base Fee Number of Rxtures
$21.00 + ( X $7.00/fixture) _ (8) Estimated Permit Fee
Estimated Permit Fee
X .65 =
Miscellaneous Fixture Charge: (10)
SUh TOM rR,nennel: Line(s)(1)+(2)+(3)+(4)+(S)+(6)+(7)+(8)+(9)+(10) = (11)
(9) Estimated Plan Review Fee