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01-103230 City of Federal Way Community Development Services Mechanical Permit #:01 - 103230 - 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: ALBERTSON'S Project Address: 31009 PACIFIC z {4 Wy s Parcel Number: 082104 9062 Project Description: MECH-Installing owner-provided supermarket refrigeration equipment Owner Applicant Contractor AMERICAN STORES PROPERTIE EDISON SOURCE EDISON SOURCE 3902 W VALLEY HWY N SUITE 206 3902 W VALLEY HWY N SUITE 206 AUBURN WA 98001 AUBURN WA 98001 (253)833-9300 Mechanical Valuation 167550 Over the Counter Permit No Mechanical Fixtures Description 1Quantityl Description 'Quantity Description Quantity Compressors 22 Evaporative Coolers 16 Refrigeration Systems 41 PERMIT EXPIRES February 26,2002,IF NO WORK IS STARTED. Permit issued on August 30,2001 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. Owner or agent: / (44+^ ga/1 1.A-, Date: F- 30 ° I w ZLIY3(o ar.Of G SO LIZ_ CONSTRUCTION PERMIT APPLICATION o � '1f' D APPLICATION NUMBER: C) L - 0_3 "3v - 00 APPLICATION NUMBER: - - . 1 /I APPLICATION NUMBER: - - **Ti�etel�9�ling is required information-Please print(in ink)or type** YCir'WLJi:� Please nuie:pJv.., ire Prevention Systems and Engineering permits may require a separate application. ■ PROPERTY INFORMATION SITE ADDRESS: "3 1 0 10 1L�1 px. s • ASSESSOR'S TAX/PARCEL #: - LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): tP-A,krAS.N 3 57 .(/--E ' ■ PROJECT INFORMATION/ TYPE OF PROJECT(This application): ❑ BUILDING CI PLUMBING LS MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL El ENGINEERING El FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): IA Sia,\\ OWY\Cr str-Ov\c\t Sv� r'rs,, vyGrkx11 Y fit\ 5 (f0-1%Y‘ e )Tyvv vci- Doe,c‘, �v ‘c., ._ 1 -kJ R�1�‘r�l . PROJECT NAME: ' A Ike 13&n ■ PEOPLE INFORMATION PROPERTY OWNER: NAME: DAYTIME PHONE: A\.btr��1�5 ( ) MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): ;). U. (3oX ZA) -g t.‘Sic, 1 l0 . x'370-1— CONTRACTOR: NAME: k DAYTIME PHONE: q S 4 N 'c oCce. (253 ) 8 33 - 3 Qc MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE: 3� ©t \A.). V a\\<N Nw\�. I) . Sv\ Z0 L (?oa) 41'1 - 5 53 CITY OF FEDERAL WAY BUSINESS LICENSE N MBER: FAX NUMBER: _ - (LS3 )/33 - 55-:. CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE: (copy of card required) ED t £ () Sit 0 2 4.- /$ F / / APPLICANT: NAME:--- DAYTIME PHONE: 1 \ '‘e, J . VAAR.Q.\S (Z53) 133- 3Q MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): T : ate ,P).0-4.. W.'V 01t1 \-1wN. SQ,1.2 L A )?Q2t /W A . .d®t (25 Zla t - rnq + ft RELATIONSHIP TO PROJECT: 11 �^ D FAX N MBER: CI ARCHITECT CI TENANT CI OTHER(DESCRIBE).�QiNS..11 '►1 GR. . (-LSI ) 3 3 -r J 155 _/ E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: CI PROPERTY OWNER CI APPLICANT L'7 CONTRACTOR ■ DETAILED BUILDING INFORMATION EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: C__ __.(X) 3) SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER: *D LAKEHAVEN El HIGHLINE ❑ PRIVATE(SEPTIC) i A • **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: ■ 'FIXTURES Indicate number of each type of fixture MECHANICAL • AIR HANDLING UNIT(S) I (o EVAPORATIVE COOLER(S) GAS LOG(S) '4"' REFRIG.SYSTEM(S) BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S) BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( ) 2.L 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.( ) INTERCEPTOR(S) 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 of this application. NAME/TITLE: ( 1 \ ` IlUAAJL. �G�V1.(\ AA CZAt• DATE: ❑ PROPERTY OWNER ❑ APPLICANT 2.CONTRACTOR 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? El YES ❑ NO SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? +• L]1(ES ❑ NO { COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129 p 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$1,000.0Qor 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) U.MECHANICAL PROPOSED VALUATION: / 6 // ,5 50. 0 d 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) • ■ PLUMBING 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)