04-105193 City of Federal Way S.
•
Community Development Services Building - Co.nmercial Permit #: 04 - 105193 - 00 - CO
Y.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: ST FRANCIS HOSPITAL SATELLITE NURSE'S STATION
Project Address: 34515 9TH AVE S Parcel Number:750451 0020
Project Description: TI-Remodel 276 sqft area on 1st floor for satellite nurses'station. No plumbing or mechanical.
Owner Applicant Contractor Lender
FRANCISCAN HEALTH SYSTEM PACIFICADD SERVICES*RAMZI F SELLEN CONSTRUCTION FRANCISCAN HEALTH SYSTEM
1717 S J ST 3601 43RD AVENUE COURT NE SELLEC*372NO 6/1/05 1717 S J ST
TACOMA WA 98405-4933 TACOMA WA 98422 PO BOX 9970 TACOMA WA 98405-4933
SEATTLE WA 98109
Includes:
Census category: 437-Comm #1 #2 #3 #4
Occupancy Group: I-1.1
Construction Type: j Type I:FR 7
Occupancy Load:
Floor Area(Sq.Ft.): �L
Building Pre-con.Meeting Required No Census Category 437-Commercial alt/add
Fire Sprinklers Yes Mechanical No
Number of Stories 3 Permit for Building Shell Only No
Plumbing No Special Inspection Required No
Will Certificate of Occupancy be Issued9 Yes Zoning Designation OP
CONDITIONS:
This decision shall not waive compliance with future City of Federal Way codes,policies,or standards relating to the
subject proposal.
PERMIT EXPIRES September 25,2005.
Permit issued on March 29,2005
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: /� j/>---
•
City of Federal Way • " •
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Section 110.2 of the Uniform Building Code certifying that at
the time of issuance,this structure was in compliance with the various ordinances of the City regulating building
construction or use. This certificate is valid ONLY when endorsed by City staff.
Tenant Name: ST FRANCIS HOSPITAL SATELLITE NURSE'S STATION Permit number: 04- 105193-00
Address: 34515 9TH S
#1 #2 #3 #4
Occupancy Group: I-1.1
Construction Type: Type I-FR
Occupancy Load:
Floor Area(Sq.Ft.):
Owner FRANCISCAN HEALTH SYSTEM
Name: 1717 S J ST
Address: TACOMA WA 98405-4933
Building Official Date
The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which experience has shown most severely
affect the health and safety of the general public. Although the City has made as complete a review and inspection as is reasonably possible(within budgetary time
and personnel limitations),the City neither guarantees nor warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance
with each and every ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon which it is
situated. Such compliance is the responsibility of the owner and/or occupant of the premises.
THIS CARD IS TO MAIN ON-SITE
CITY OF ti ommunty Developnnt Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-105193-00-CO
Owner:
Address: 34515 9TH AVE S
FEDERAL WAY, WA 98003-6761
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
0 Footings/Setback(4110) .❑ Foundation Wall (4115) 0 Drainage/Downspout(4040)
Approved to place concrete Approved to place concrete Approved to backfill
By Date By Date By Date
❑ Re-steel(4215) e❑ Plumbing Groundwork(4190) • ❑ Slab/Concrete Floor(4255) ,
Approved to place concrete or grout Approved to cover Approved to place concrete
By Date By Date By Date
❑ Underfloor
•
Framing (4285) ❑ Floor Sheathing(4105) •❑ Shear Walls (4245)
Approved to sheath floor Approved to install flooring Approved to install siding
By Date By Date By Date
0 Roof Sheathing (4220) ❑ Fire/Draft Stops (4095) NOTE: Prior to scheduling a Framing(4120)
Approved to install roofing Approved inspection;Electrical,Plumbing&Mechanical
Rough-in and Fire/Draft Stop inspections must be
By Date By Date signed-off and approved. IBC 109.3.4/UBC 108.5.4
,V] Framing (4120) 0 Insulation (4150) '�Gypsum Wallboard Nailing(4130)
Approved to insulate Approved to install wallboard Approved to install mud tape
B• W:\ Date ByDate B �* Date
l` �� `�1 f , • . � M X7 ,
e❑ Suspended Ceiling Grid (4265) • ❑ Final-Fire Department (4060) �❑ Final-Planning(4070)
Approved to drop tile Approved Approved
By Date By Date By Date
, .
ix, Final-Public Works (4080) a Final-Building(4050)
Approved Approved
It i
By ' * ' Date E 1 I 74 0'-) B �A Date z
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Federal Way T �� �/ ‘.5 / q 3
COMMUNITY DEVELOPMENT SERVICES � y,/S:�i IT SF MF • E EL PL DG EN FP
3332FEAVEWAEYSOUTH8:603V-89718
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P L I C A T I O N IT. /
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253-835-2607•FAX 253-835-2609
unau..mloffederahcaq"cram CITY
YRI'OFnnFEDERAL WAY
The following is required"fif)1Tl'flfdgdt4EPJn incomplete ap lication will not be accepted. Please print legibly(in ink)or type.
PROPERTY INFORMATION
SITE ADDRESS 34 \'D 611=6` AVeA � ' OjA t coC10-A(_ ("/14Y SUITE/UNIT #
ASSESSOR'S TAX/PARCEL# LOT SIZE (Sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) "''''E" 4-/ n,, _ /• cot/e S ff C j •
/Attach separate page jar lengthy legal deco prion)
.-.,:-.„,. .,:ii.:,.....:.: :- ■ PROJECT INFORMATION • -
TYPE OF PERMIT UILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
4 1 . F-P_-+r t4c s +b543;1-144._- , -t -• -Rood 54.1 i ic N uv2 s 4-li o,4
Ar ►D iTi o N • o rL • _ ., Q. 7 TO7q— E10:),41-1-e0 A-LcA .
PROJECT NAME(Name of Business or Owner Last Name) ST• FR-.4 isC.-G $ k+oS P i j r4-L_ 15-1: l'LGt442- /V 5
_ PEOPLE'INFORMATION _
PROPERTY NAME
�-•t' F{L^ ,1 N� A-- O i -L_ PRIMARY PHONE
OWNER 1. ..�•}- \ i (253) 4-2_G-6S 35
MAILING ADDRESS CITY,STATE,ZIP
t3t�- 501.cm T -5n2-es--17 "T'Ae-,DA14-/ LA-A 3 61,giOj
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
50-(-6n4 C $e_LA Orl ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMB ER
— —
I I ( )
B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each applcatioa( EXPIRATION DATE
se-u-ec•44" 32. NO / /
APPLICANT COMPANY NAME LICANT NAME OFFICE PHONE
'P•A+G Pic-ADD Si24 i ce5 .g•14-►v•2:1 k1-r¢O o.9-D , (25-3)46S -( -
MAILING ADDRESS I, IT`S;SATE,7IP -"""ice' LL PHONE
u-ot 43C Ave• C .. Nre- l'Ac o)✓+)4, LA 141 411- ) -
RELATIONSHIP TO PROJECT FAX NUMBER
)(Architect o Tenant ❑Agent 0 ther(Describe) (.263) 1 43 - I1:t
CONTACT NAME1� PRIMARY PHONE E-MAIL ADDRESS I 1 1
LENDER
Per RCW 19.27.095: Lender information is NAME 1.M
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
.■ DETAILED BUILDING INFORMATION •
EXISTING USE S I T}4-C_`_ PROPOSED USE Kt) C {V Ej`.
EXISTING ASSESSED/APPRAISED VALUE $ �i`1vj 5f'• VALUE OF PROPOSED WORK $ 2-4 ODD•
SPRINKLERED BUILDING? RYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL) l a((S('
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) ^
PROJECT FLOOR AREAB;
AREA DESCRIPTION EXISTING SQ. FT. PR. •SED SQ.FT. TOTAL
BASEMENT ang.•.....P
FIRST C.t ST .e)‹.1 S-1 IND C44- '�c- .
-t
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Y .""` - ,� --:pn.4 ct. '2 .j ,� pper�... 3
fit.,- .4 s� tey i ,riAi V+�4 V. Z. r° ,"✓ c ;' .
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL • /
Value of Mechanical Work $ 6444 I I EA/9'
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(comm ai WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS torTub/sh...«Combo) SHOWERS WATER CLOSETS rro.<q MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
',,-' WASHING MACHINES URINALS HOSE BIBBS
,1 LAVS BauvoomSu.,ks VACUUM BREAKERS ELECTRIC WATER HEATERS
.� ' :*-ti ` °i/SCI:AirtERJSIGNATQRtili6C8,l" '4
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 relia e 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 Z/ -7 6L, 0141 167'''GrDATE /0//1-3/D ,"
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent 0 Contractor Architect 0 Other
i
( FOR OFFICE USE ONLY
o NEW o ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT
E BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
r NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES 0 NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
II
Bulletin#100-March 30,2004 - Page 2 of 4 k\Handouts-Rcvised\Pcrmit Application