01-101131 ,
City of Federal Way
Community Development Services Mechanical Permit#:01 - 101131 - 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: GERLT ei 6
Project Address: 31900 53RD/SW Parcel Number: 189860 0140
Project Description: MECH-Gas furnace replacement in existing single family residence
0 Owner Applicant Contractor
Richard L&Larissa G Galt NONE AFFORDABLE GAS SERVICE
31900 53RD AVE SW AFFORDABLE GAS SERVICE
FEDERAL WAY WA 12955 22ND AVE NE
98023-2027 NONE (206)367-5333
Mechanical Valuation 1800 Over the Counter Permit Yes
Mechanical Fixtures
Description QuaMi _'''' wi t'""Description Quantity . Description Quantity]
Furnaces 1
PERMIT EXPIRES September 19,2001,IF NO WORK IS STARTED.
Permit issued on March 23,2001
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.
//1 .
Owner or agent: //(0,
in Iw Date: 3 (23 9 i
,;?g / gr(1/)�
0igi ,7
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cn.°r CONSTRUCTION PERMIT APPLICATION
VV F3Y E " I ED APPLICATION NUMBER: of - (2/j' _ -(JoTj-
APPLICATION NUMBER:
It \>ti MAR 2 3 Ir A APPLICATION NUMBER: - -
**C t ��ortud,ir�cNikdd information-Please print(in ink)or type**
DING
Please note: Electrical, r , reveevenDEPT.
tion Systems and Engineering permits may require a separate application.
11111111111111111111111111111111111111111111.1111111.1111111111111
SITE ADDRESS: 3/9/90 OQ 3 3-d 4i Sc....) ASSESSOR'S TAX/PARCEL #: / 174,6 O - 6` / D
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT(This application): ❑ BUILDING El PLUMBING M ' ECHANICAL El DEMOLITION
❑ ELECTRICAL CI ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): /4 c2 '( STi 4 o� 5 a,) Ce
PROJECT NAME: L6 i/$sq 6(c)y/�
PROPERTY OWNER: NAME: 2---K4,1
� DAYTIME PHONE:
Z ci,(5f A 6v/7L (Z-5 ) 922-5- F88)-
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME:�1 DAYTIME PHONE:
4rgriug. 64,5 Su.)f.2 (2,96 ) 34/ - .5333
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
/2-953— 2z ,,Q_ ,(,)—_ : Wim. 9 /E5' ( ze6 ) 341 - c533
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
12 - L72 Z ci - Do (2-o6) '367, 5-333
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) 4- / C o/Z ( S o '2 2-4 3 / ! -7 / -t Z
APPLICANT: NAME: 1--) DAYTIME PHONE:
rows ( '2o6) j4.-) - 6333
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
/z9rT 2z 4-- ,QQ St..I7/ i✓JA 5'.7'z ( ) (' -
RELATIONSHIP TO PROJECT: / // FAX NUMBER:
❑ ARCHITECT ❑ TENANT IS-Of HER(DESCRIBE): 60'1-'64,�•�z✓ ( ) N - r
�� E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: [SPROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR �C,<S.M 4„,e,s,,, co, vK
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ �q
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ /Q/�vv
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
•
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
•
■ PROSECT 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
sr:
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) / FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC AS
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.( )
INTERCEPTOR(S) SUMP(S)
; iwE,`.a:61ER./SIGNATO E EL: r
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 th• as a part of this application.
NAME/TITLE: In Calw DATE: 3/ Z 3�O I
L7 PROPERTY 'INNER CI APPLICANT [-CONTRACTOR 111
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? ❑ YES Cl 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
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
•
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)$501.00 to$2,000.00 (2)$24.25 for the first$500.00 plus$3.27 for each additional$100.00 or 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$1,000.00 or fraction thereof,to and including
$25,000.00
(4)$25,001.00 to$50,000.00 (4)$403.61 for the first$25,000.00 plus$10.82 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$7.50 for each additional$1,000.00 or fraction thereof,to and including
$100,000.00.
(6)$100,001.00 to$500,000.00 (6)$1,025.55 for the first$100,000.00 plus$6.00 for each additional$1,000.00 or 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$5.09 for each additional$1,000.00 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$1,000.00 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 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)
c, ■ MECHANICAL
PROPOSED VALUATION: / aOO
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
• - ■ 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: (7)
Base Fee Number of Fixtures
$21.00+{ X$7.00/fixture}= (8)Estimated Permit Fee
Estimated Permit Fee
X .65 = (9)Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
Sub Total (Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)