02-104618City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Mechanical Permit #:02 -104618 - 00 - ME
Project Name: VOSS
Project Address: 4622 SW 328TH P
Project Description: MECH - Gas furnace changeout in existing residence.
Inspection request line: 253.835.3050
Parcel Number: 802950 0040
Owner
Applicant
Contractor
Stephen M & Vicki L Voss
FEDERAL WAY HEATING INC
FEDERAL WAY HEATING INC
4622 SW 328TH PL
35002 PACIFIC HWY S
35002 PACIFIC HWY S
FEDERAL WAY WA
98023-1925
35002 PACIFIC HWY S!FEDERAL WAY, WA
1 (253) 835-9515
Mechanical Valuation..........................................1400 Over the Counter Permit ...................................... Yes
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 ag Date: ra
cffyor/G— RECEIVED CONSTRUCTION PERMIT APPLICATION
uv FiY1--APPLICATION NUMBER:
OCT 1 S 2002 APPLICATION NUMBER: — —
CITY
II IO''F FEDERAL WAY APPLICATION NUMBER:
**The folPb JQ'N9eQ&PeTd information - Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTYINFORMATION
SITE ADDRESS: ��� S", X97`0A ASSESSOR'S TAX/PARCEL #: �v � qJ D - 0 o4/
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PR03ECT INFORMATION-.
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING gMECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): 2IEPJ- AC C iJc,r te-D4
•• r
■ PEOPLE INFORMATION
PROPERTY OWNER:
CONTRACTOR:
NAME: DAYTIME PHONE: 0
5 1 ��� lefS ,S `J83 -6
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, IIP):
TX o.c ����,e>g�7 c�a 990a3
NAME:
PHONE:
❑ YES L'9'NO
WATER SERVICE PROVIDER:
/DAYTIME
� s�
MAILING ADDRESS (STREET ADDRESS;,
STATE, ZIP):
EVENING PHONE:
x C .
2 , / f W TT
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBkA:
FAX NUMBER:
_ _ - _ _ _ _ _ _ --
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
(copy d -.a Ked)
D9 9 4�0_®/�� _
/a l <n
APPLICANT: NAMe�d DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, ATE, ZIP): EVENING PHONE:
3 42:n'O.P c,�R ► ( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): a-�.4 eOF_ ( )
�� E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT LlCONTRACTOR
EXISTING USE:
■ DETAILED BUILDING INFORMATION "
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE:
SPRINKLERED BUILDING?
❑ YES L'9'NO
WATER SERVICE PROVIDER:
6KEHAVEN
SEWER SERVICE PROVIDER:
BI KEHAVEN
PROPOSED VALUATION FOR IMPROVEMENTS: $
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
0 HIGHLINE . 0 PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ 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:
.�. ...- _ .- _ ..>�.�_�..,t:ti«>. .. s<ica'sxvrra.h'+sCsi4�iJ.�niR��i■E:FiA�URESJtn;.6www+ i:t'iii+e-.r.:+wn.s�+.e.:e�s�:r3:i.i��;.ie*rs++'t:+i�s�i'r4riw �:v:i�.aaN`��.,.••k�.r,y..
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACE INSERT(S) RANGE(S) MISC. ( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC El 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) SINK(S) WATER CLOSET(S) MISC. ( )
INTERCEPTORS) SUMP(S)
` ■ DISCLAIMER/SIGNATURE BLOCK -
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 ofi1 nlitati `n.
NAM E/TITLE:
❑ PROPER ER ❑
DATE: /0— 1'f--d�G
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL. WAY, WA 98063-9718 •253-661-4000 • FAX: 253-661-4129
www.dtyoffederelway.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.
TABLE A
TOTAL VALUATION
FEE FACTOR
(1) $1.00 to $500.00
(1) $26.00
(2) $501.00 to $2,000.00
(2) $26.00 for the first $500.00 plus $3.50 for each additional
$100.A0 or fraction thereof, to and including
$2,000.00
(3) $2,001.00 to $25,000.00
(3) $78.50 for the first $2,000.00 plus $15.50 for each additional51.000.00or
fraction thereof, to and
including $25,000.00
(4) $25,001.00 to $50,000.00
(4) $435.00 for the first $25,000.00 plus 511.00 for each additional
51.000.00 or fraction thereof, to and
including $50,000.00.
(5) $50,001.00 to $100,000.00
(5) $710.00 for the first $50,000.00 plus 58.00 for each additional
51.000.00 or fraction thereof, to and
including $100,000.00.
(6) $100,001.00 to $500,000.00
(6) $1,110.00 for the first $100,000.00 plus $6.00 for each
additional $1,000.00or fraction thereof, to and
including $500,000.00
(7) $500,001.00 to $1,000,000.00
(7) $3,510.00 for the fist $500,000.00 plus 55.50 for each
additional $1.000.00 or fraction thereof, to and
including $1,000,000.00.
(8) $1,000,001.00 and up
(8) $6,260.00 for the first $1,000,000.00 plus $4.00 for each
additional $1.000.00 or fraction thereof.
Bold number is the base fee for the specified increment
Italicized, underfined number Is the fee per additional specified
increment
PLUS: 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 Fre 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 Fre Department Surcharge: (3)
(COMMERCIAL ONLY)
(a) Base Fee:
(b) Additional Increment Fee:
0 MECHANICAL
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee:
Estimated Plan Review Fee:
■ FIRE PREVENTION SYSTEM
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(b) Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: m
Base Fee Number of Fatures
$22.50 + ( : X $8.00/fixture) = (8) Estimated Permit Fee
EstimaWd 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