01-102182City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003 -6210
Pit: 253.661.4000 Fax: 253.661.4129
Building - Commercial Permit #:01- 102182 - 00 - CO
Project Name: GROUP HEALTH
Inspection request line: 253.835.3050
Project Address: 301 S 320TH ST Parcel Number: 172104 9105
Project Description: TI - Interior remodel to create new restroom, includes plumbing and mechanical.
Owner
Applicant
Contractor
Lender
GROUP HEALTH COOP & PUGET *
COLLINSWOERMAN
OGIY(,P/I-
GROUP HEALTH COOP & PUGET
521 WALL ST
777 108TH NE, #400
Construction Type:
521 WALL ST
SEATTLE WA
BELLEVUE WA 98004-5118
No
SEATTLE WA
98121 -1524
Will Certificate of Occupancy be Issued? ............
No
98121 -1524
Includes:
Census category: 437 - Comm
#1
#2
#3
#4
Occupancy Group:
1-1.2
Number of Stories .................. ..............................1
Permit for Building Shell Only_ ..........................
Construction Type:
Type V - One -HR
Plumbing.................. ...............................
No
Occupancy Load:
No
Will Certificate of Occupancy be Issued? ............
No
Sensitive Areas? .................. ...............................
Floor Area (Sq. Ft.):
Zoning Designation.............. ...............................
OP
Building Pre -con. Meeting Required,...... .... _ ...... No
Census Category .................. ...............................
437 - Commercial alt/add
FireSprinklers .................. ............................ ...
Yes
Mechanical.................. ...............................
Yes
Number of Stories .................. ..............................1
Permit for Building Shell Only_ ..........................
No
Permit for Foundation Only .... .............................No
Plumbing.................. ...............................
No
Special Inspection Required . ...............................
No
Will Certificate of Occupancy be Issued? ............
No
Sensitive Areas? .................. ...............................
No
Zoning Designation.............. ...............................
OP
Plumbing Fixtures
VNFDescr'tpfionm fir: (2uant
Description .'
Quanti
Description Quanti
Lavatories 1
Other Plumbing Fixtures
2
Sinks
Mechanical Fixtures
k. Description 's ' Quanfity Description '... Quantit Description Quantit''
Fans 2
PERMIT EXPIRES January 28, 2002, IF NO W(
Permit issued on August 1, 2001
I hereby certify that the above information is correct and that the construction on the al
the occupancy and the use will be in accordance with the laws, rules and regulations of
the City of Federal Way.
Owner or agent: Date: _ 4.—
0
INSPECTION LOG
DA' E
, NSPECTOR
OK
CORR/REJ
AREA AND TYPE OP I SKMON
--/A
p l tkV* b Par b a
POQfHIS CARD ON THE FRONT OF BUIL
OE rXF11. BUI DING DIVISION
N - INSPECTION RECORD
INSPECTION REQUEST PHONE #: 253- 835 -3050
PERMIT #: 01- 102182 -00 —CO
OWNER'S NAME: GROUP HEALTH COOP & PUGET *GROUP HEALTH COOP S
SITE ADDRESS: 301 S 320TH
( ) FOOTINGS /SETBACKS
( ) FOUNDATION WALL
. >i . .. �3►�'N �' "t� �. N ,y,� � � (; �Y F OWED f u b � � ���Ny �� � � �` � �x��
( ) DRAINAGE: Line
( ) Connection.
- /V- 0 / c. 1-J
() ROUGH PLUMBING: DWV Water
() ROUGH MECHANICAL Gas p
( ) SHEATHING
( ) SHEAR WALLS
( ) ELECTRICAL ROUGH -IN.
( ) FIRE/DRAFTSTOPS
- '! ft-1 -
Roof Floor.
Ditch Cover
.0�`�Q)DPOR(1�S i+CRTROOING
( ) INSULATION: Floors a s Attic
( ) WALLBOARD NAILING
( ) ELECTRICAL FINAL /!�! r Z - 2- 6 " o /
( ) PLANNING
( ) PUBLIC WORKS FINAL,
( ) FIRE FINAL,
( ) BUILDING FINAL 5 — Z , 7 - 0 / <=�
( ) SUSPENDED CEILING
r y
0 R5 �'�
C" OF G RECE!VED CONSTRUCTION PERMIT APPLICATION
PPUCAT,ION NUMBER: , P f I a 4jj YXI C'
—
jUN 0 4 /,t. PPUCATION NUMBER: - - - -
Qj I Y, WAY APPLICAMN NUMBER. _
_IVILVING DEPT.
* *The fo owing is required information - Please print (in ink) or type **
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
2
PROPERTY INFORMATION
SITE ADDRESS: 7�. ASSESSOR'S TAX /PARCEL #: 1- 7- —7-4 Pp g
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): '� e F- DP-AW IN6 S
TYPE OF PROJECT (This application): 'BUILDING ')LUMBING MECHANICAL ❑ DEMOLITION
((❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide, dptallqd description):
PROPERTY OWNER:
� �'7trntv'xi
CONTRACTOR:
APPLICANT:
CONTACT PERSON
NAME: DAYTIME PHONE:
C� ro �Fpc {n. l� rinWle C(ra �Z�ts) 4/
MAILING ADDRESS (STREEIr ADDRESS; CITY, STATE, ZIP): ii AA,
NAME: .+�.� -,yam
i • L?
DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
(
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
_ _ - _ _ _ _ _ _ - _ _
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
NAME: I�
+
DA ME PHONE:
ZS
- 53
MAILING ADDRESS (STREETT ADDRESS; CITY, STATE, ZIP): C Q�
�7 1O V" E L fig-
�PV IV
EEVENING PHONE:
RELATIONSHIP TO PROJECT:
ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE):
FAX NUMBER:
( )
-
=0R THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
E -MA ADDRE
c0' A.•s to,
PROPOSED USE: G t �� PROPOSED VALUATION FOR IMPROVEMENTS: $ ��
SPRINKLERED BUILDING? I11,ES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
ierK*"
, Cow%
•
•
WA SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA o PRIVATE (WELL)
SEWER SE CE PROVIDER: o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
* *NEW RESIDENTIA =ONSTRUcriON ONLY ** NUMBER OF ESTIMATED SELLING PRICE: $
FLOOR
XI G
E . FT.
PROPOSED S . FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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)
BOILER(S) FIREPLACEINSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINALS) WATTCR H.EATER(S)
DISHWASHER RAIN WATER VACUUM BREAKER(S) kECT IC ❑ GAS
DRINKI UNTAIN(S) SHOWE _ _WASH MACHIN T y��,j
G E OUTLETS) SIN _ WATER CL (S) _Oz_ MISC. / / �C�(_ .
TERCEPTOR(S) P(S)
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 w1lere such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy
of the information suppffs the 'ty as a part of this application.
NAME /TITLE: DATE: &
❑ PROPERTY OWNER APPLICANT ❑ CONTRACTOR
r o 6
FOR OFFICE USE ONLY:
0 NEW o ADDMON ALTERATION o REPAIR o TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE: r , 1
ZONING DESIGNATION :
BUILDING SHELL', ONLY? ❑ YES S,-,NO'
COMP PLAN DESIGNATION
SECTION TOWNSHIP RANGE
BASIC PLAN? ❑ YES Q NO
NEW ADDRESS REQUIRED? ❑ YES a NO
PLATTED LOT? n YES ❑ NO
CHANGE OF USE?: o 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) $23.50
(2) $501.00 to $2,000.00
(2) $23.50 for the first $500.00 plus $3.05 for each additional $100.00
or fraction thereof, to and including $2,000.00
(3) $2,001.00 to $25,000.00
(3) $69.25 for the first $2,000.00 plus $19.00 for each additional 51.000.00
or fraction thereof, to and including
$25,000.00
(4) $25,001.00 to $50,000.00
(4) $391.25 for the first $25,000.00 plus $10.10 far each additional
81.000.00 or fraction thereof, to and including
$50,000.00.
(5) $50,001.00 to $100,000.00
(5) $643.75 for the first $50,000.00 plus $7.00 for each additional
51.000.00 or fraction thereof, to and including
$100,000.00.
(6) $100,001.00 to $500,000.00
(6) $993.75 for the first $100,000.00 plus $5.60 for each additional
SI.000.00 or fraction thereof, to and including
$500,000.00
(7) $500,001.00 to $1,000,000.00
(7) $3,233.75 for the fist $500,000.00 plus $9.75 for each additional
81.000.00 or fraction thereof, to and including
$1,000,000.00.
(8) $1,000,001.00 and up
(8) $5,608.75 for the first $1,000,000.00 plus $? 65 for each additional
81.000.00 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 **
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee:
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
(a) Base Fee:
(b) Additional Increment Fee:
(a) Base Fee:
(b) Additional Increment Fee:
■ FIRE PREVENTION SYSTEM