01-101997 r I 1
City of Federal Way
Community Development Services 'Electrical Permit #:01 - 101997 - 00 - EL
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: EVERETT MRI&DIAGNOSTIC CENTER
Project Address: 922 S 348TH 5+ $Id9 $ Parcel Number: 202104 9101
Project Description: EL-Install 800-amp service to building for MRI; refeed existing 200-amp service for house panel.
Owner Applicant Contractor
EVERETT MRI AND DIAGNOSTIC CENTER ACKER ELECTRIC ACKER ELECTRIC
922 S 348TH ST 2204 260TH AVE SE 2204 260TH AVE SE
FEDERAL WAY WA MAPLE VALLEY WA 98038 MAPLE VALLEY WA 98038
98003 (206)396-3867
Electrical Fixtures
i, . ; Descriptions' s 'Quantity' Description-'Cz,akil Quantity 6. .;, . :.;Description (Quantity
Alt.Serv./Feed 601 amps-1000 amps- 1 Alt.Serv./Feeder up to 200 amps-Col 1
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PERMIT EXPIRES December 4,2001,IF NO WORK IS STARTED.
Permit issued on June 7,2001
I hereby certify that the above information is correct and that the construction on the above described property and 0
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: __.- L' Z-1__ Date: 6. /-'U/
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30/2001 15:37 FAX 2536614129 CITY FEDERALWAY 2002
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c c, CONSTRUCTION PERMIT APPLICATION
L� PPLICATIGN NUMBER: Q - L 0 L 5',-E L-
@�ip' 01 AI.APPLICATION NUMBER; — — - - —i
LA l y OFF FELJERAL WAY APPLICATION NUMBER; -
BUILDING DEPT.
"The following is required information-Please print(in ink)or type"
Please note: Electrical,Fire Prevention Syslems and Engineering permits may require a separate appiication.
1 PROPERTY INFORMATION
SITE ADDRESS- Z 5- 3 Ylf1:1457- Femme= u/A'Y ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): -
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): U EU • •` LUMBING 0 MECHANICAL 0 DEMOLITION
;g1 NGINEERINGD -E PREVENTION SYSTEM
PROJECTD IPT (Prov detaile. •scrip.
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1 PEC"LE NFORMA"I MIIIIIIIIIIII _ mo-:":ON
PROPER ,WNER: I Nit %la
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MAILING AI)ORCG4 ••CL•T AO+• + y V' '. •
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CONTRACTOR: NAME: , DAY:IP E PHONE'
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MAILING ADDRESS' SI . A I ,STATE. -): tVENI NG el C.NF:
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Cl I'V Di rTDERALVJRY; ES_ _,E NUMBER: .M, --- FAX NUMBER:
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CONTRACrOA<REGISTRA . 'UMBER _ EXPIRATION PATE:
(cony of card require ) / /
APPLICANT: N DAYTIME PHONE: -
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MAILIN�51I(MEET
CII v,,STATE,ZIP): EVENING PHONE.
200e,7/ ? .jRvc3F_ "9- 1rvicz ey ,u/� 9803 (V ) ) 4'3Z - 79y3
RELATIONSHIP?0I'ROJILI: E/ �Z PUCNLM7BE^;
0 ARCHITECT 0 TENANT D OTHER(DESCRIBE): c?r).-1 Pei9e--7uP (4!Z j) (13 e--- 7873
E-MAIL ADDRESS
CONTACT PERSON FOR THIS PROTECT: 0 PROPERTY OWNER 0 APPLICANT 0 CONTRACTOR L
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHUNE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
04/30/2001 15:38 FAX 2536814129 CITYFEDERALWAY 2 003
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*=NEW RESIDENTIAL.CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ ,„
• _ • . . .
FLOOR EXISTING S•.FT. PROPOSED •.FT. OTAL ,
BASEMENTPrir
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK A
GARAGE
________
_-
HOW MANY FLOORS? -
TOTAL:
• 'FDCTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UN r (S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BSQ(S) _ FAN(S) HOOD(5) WOODSTOVE(S)
— BOILER(S) — FIREPLACE INSERT(S) RANGE(S) MISC.(__
COMPRESS• -(5) FURNACE(S)
DUCT(5) GAS PIPE OUTLETS) HEAT SOURCE: ❑ELECTRIC 0 GAS
PLUMBING
_ =,THTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. _ VACUUM BREAKER(S) 0 ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
— GAS PIPE OUTLET(S) SINKS) 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 = a such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information supp,to the 4city a as a part of this application.
al r DATE: 5- / t
NAME/TITLE:
-
❑ PROPERTY OWNER ❑APPLICANT 0 CONTRACTOR
FOR OFFICE USE ONLY:
_❑ NEW 0 ADDITION ❑ALTERATION 0 REPAIR 0 TENANT IMPROVEMENT
CENSUS CODE: • LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? ❑_YES C-.1 NO
COMP PLAN DESIGNATION BASIC PLAN? 0 YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? 0 YES ❑ NO
PLATTED LOT0 YES 0 NO CHANGE OF USE? 0 YES Q NO
rnti uNTTY oeVELOPMENT SERVICES•3353C FIRST WAY SpuTrl-P.O.BOX 9716-FEDERAL WAY,•AA 9a063.0715•253-661-4000•fAX:353-651-4129