12-104256 • •Building Commercial
City of Federal Way Permit #: 12-1042S6-00-CO
Community&Econ.Dev.Services
33325 8th Ave S
Federal Way,wA3 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: KHO,DDS
Project Address: 33915 1ST WAY S Unit 201 Parcel Number: 926504 0150
Project Description: TI-tenant improvements for new dental office,including partition walls,acoustic ceiling&
finishes. Includes plumbing,mechanical by separate permit.
Owner Applicant Contractor Lender
CUNA MUTUAL INVESTMENT CHRISTINE BENDA SAFFLE COMPANY INC COLUMBIA BANK
CORP SJ BARRETT&CO,INC SAFFLC*001P1(10/21/12) 11225 61'H ST SUITE 100
5910 MINERAL POINT RD 221 28TH ST S SUITE 100 7350 CIRQUE DR W SUITE 202 BELLEVUE WA 98004
MADISON,WI 53701 TACOMA WA 98402 UNIVERSITY PLACE WA 98467
Census Category: 437- Commercial alt/add/conversion
Includes: #1 #2 #3 #4
Occupancy Class: B
Construction Type: Type II-A
Occupancy Load: 19
Floor Area(sq.ft.) 1,807 0 0 0
Additional Permit Information
Building Pre-con.Meeting Required? No Existing Sprinkler System in Building? Yes
Mechanical to be Included? No Number of Stories. 2
Permit for Building Shell Only? No Plumbing to be Included? Yes
Special Inspection(s)Required? No New/Additional Sq.Feet-Total 0
Occupancy#1-Use Professional Zoning Designation. OP
Services/Offices
Plumbing Fixtures
Drains 1 Laundry Washer Outlets. 1 Lavatories 6
Sinks 2 Water Closets 2 Water Heaters
PERMIT EXPIRES Wednesday, April 3, 2013
Permit Issued on Friday, October 5, 2012
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 �7. _ Date: i0/.5�-/L
F( ALL zft &fiz
Ai
r
City ofsFederal Way
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Section 110.2 of the International 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: KHO,DDS Permit#: 12-104256-00-CO
Address: 33915 1ST WAY S Unit201
Includes: #1 #2 #3 #4
Occupancy Class: B
Construction Type: Type II-A
Occupancy Load 19
Floor Area(sq.ft.) 1,807 0 0 0
Owner Name: CUNA MUTUAL INVESTMENT CORI
Owner Address: 5910 MINERAL POINT RD
MADISON,WI 53701
L.&— Q.Q a /Zit'/2
I:uilding 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 severly 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.
BATE INSPECTOR AREA AND TYPE C NSPECTION,
THIS CARD IS TO MAIN ON-SITE
Construction In ection Record
CITY OF
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 12-104256-00-CO Address: 33915 1ST WAY S Unit 201
Project: CUNA MUTUAL INVESTMENT COF FEDERAL WAY, WA 98003
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.
O SWM Precon Site Mtg(4400) ❑ Initial Erosion Control(4365) 0 Footings/Setback(4110)
Approved To be done prior to breaking ground Approved to place concrete
By Date By Date By Date
O Re-steel(4215) 0 Plumbing Groundwork(4190) E Slab/Concrete Floor(4255) '
Approved to place concrete or grout Approved to cover Approved to place concrete
By Date By Date By Date
. •
O Underfloor Framing(4285) 0 Floor Sheathing(4105) 0 Rough Plumbing(4230) '
Approved to sheath floor Approved to install flooring Approved
By Date By Date By Date
.El Fire/Draft Stops(4095) .El Interim Erosion Control(4370) ' Prior to scheduling a Framing inspection;
Approved Approved Electrical,Plumbing&Mechanical Rough-in and
Fire/Draft Stop inspections must be signed-off and
By Date By Date approved. IBC 109.3.4
❑ Framing(4120) .El Insulation(4150) El Gypsum Wallboard Nailing(4130)
Approved to insulate Approved to install wallboard Approved to install mud&tape
ByzCs Date I o-zc/Z By Date By QA
, Date -• -r1
❑ Suspended Ceiling Grid (4265) ' 0 Final-Fire Department(4060) 0 Final-Planning
Approved to drop tile Approved Approved
By cif Date l/-et? /2_, By ,jJ72._ Date /4..../v,/f2_ By Date
0 Final Erosion Control(4375) El Final-Plumbing(4075) El Final-Building(4050)
Approved Approved Approved
By Date Bye... ....,
yG ..., Date \ Z-1 ,-1 Z., , By Date/2 -/8-/2,-
❑ Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
. Federal PERMIT F MF • ME PL DE EN FP
CEIVED
COMMUNITY' 07*FA 253-85-2609SERVICES APPLICATION /0/f/4?---)
253-835-2607*FAX 253-835-2609 I�O�A
WIMP cityo�ederailCall.colli EP 18 L ?. v
SITE ADDRESS CITY °I- FEDCRAL WAY
SUITE/UNIT#
361 tS 1S4"C*a(4 S. JO
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ Vi , 11p 1 Z V5 o 4 - Q 1 5 0
TYPE OF PERMIT XBUILDING ,r..1. 0 PLUMBING 0 MECHANICAL
KDEMOLITION ❑/�ENGINEERING
,/� ❑ FIRE PREVENTION
(Tena
NAME O meoowne��Name) D( . Pa+y i cA c&. t J 1 V
1`b0-! Sat F-)-- T.! . a now stet 1+a t chili• i G ivy of 1NeVtotslti
PROJECT DESCRIPTION j,
Detailed description of work to oewv ie d. at va( V* sAt4e •iM� �j r e* 1/iav& � of-
be
be inchtripd on this permit only exp si illo n�'e./wo - .,a I 4,0041191s(, ar,1 o".' non•myvai �(
pat-1;4;04c
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PROPERTY OWNER C UN P Y ukv a t t vw'I""V' t i esif bot p. �*' P.
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Cheat fi sag �IS IO2
NAME Sa f Ix- Co. Inc-
PHONE 0(054
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CONTRACTOR MAILING 50 (,ireiUC c)'v(' Wet 1SuI4c 202 B-MAIL
....... -:-?,-:-C?, it ve&ti 'tau- STATE C 84(01 FAX293 5b4.I52 T
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
5AFFL.0 OOIPI to 2.1 itZ 1�• 12 •to412.tv'no•&t,
NAMEST ?cw/e-H- 4 Go, , l nc, .- USA+/-WL. Py3.s'13.O2.Oo
APPLICANT " . 2 a&_ Cu,1c 1� 5+i .6. 16.rrsit-c.
f�� (/C7t n I c� 'it~ t WlY l `U�l C"R
CIT ^�',�w I • W ZIP%402 F,3. 212Ae
PROJECT CONTACT NAME n`',,\^y 'C j,\^,, ,^�� PHO 3.O
(The individual to receive and VY , J I I► w I ` � '�j�
respond to all correspondence Q e -+�
concerning this application) Z2‘ S S. W J r. 0 t lw C 5vvo bet WA-VA-441
ALTERNATEcgrauoityvt.' COt Gl PHONE Soca'Sl bare'-t-.c ►el
PROJECT FINANCING NAmit Co IU ON b$ Q blk. 0 OWNER-FINANCED
Required value of$5,000 or moreADDRESS, C_�j� /yam �/ Q�/�y ��/� [� /y�
/RCW 19.27.095) t �nfiv S CLAI 'i�] 1 1 1 le e. 16001 .445
r `�OA Y l
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge,the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
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,
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.
SIGNATURE: C"1hh1OA,t 61/171/tDATE '• I • I z
PRINT NAME: CA v`cn )r/in 1
. 4 : 44 . 41 •
MECHANICAL FIXTURES
VALUE OF MECHANICAL WORN $ ( (a co or estimate must be provided)
Indicate how many of each of vcture to y, 1 • . -• or d as part of this project. Do not inch de existing fixtures to remain.
AIR HANDLING UN 'el S GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER 1 A1' REPLACE INSERTS HOODS(commerdat)
BOILERS ( r44" FURNACES HOT WATER TANKS(Gas)
COMPRESSORS IIGAS LOG SETS REFRIGERATION SYST
DUCTI GAS PIPING WOODSTOVES
PLUMBING FIXTURES
Indicate how many of each type of fvrt�u�re to be installed or relocated as part of this projt. Do not include existing fixtures to remain.
Rib/ShowerI
BATHTUBS(or W
Rib/Shower Combo) LAYS(Hand Sinks) y TOILETSV WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS 2 SINKS(Kitchen/uutuy) i WATER HEATERS(Eketri)
HOSE BIBBS SUMPS I WASHING MACHINES ' TOTAL FIXTURES
GENERAL
EN ERAL INFORMATION
CRITICAL AREAS ON
� „t
OPERTY? WATER PURVEgOC R SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
4 (--,.._...._-,
EXISTING 0' ' S USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINELER SYSTEM? PROPOSED FIRE SUPPRESSI N SYSTEM?
kr ' 'es ❑ No ❑Yes
11
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE 0 CARPORT 0
OTHER(describe)
Area Tot TOTAL
Pam
**NEW ROBINS ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEw/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square FeetType Stories
TOTAL BUIUMNG 3318 R11 "' t t•Ac Z�(M
TENANT AREA ONLY $V� B W J S j 1 1•A 20 9 VI —(i r+;al—
PROJECT AREA ONLY 1� �l tea. It GG��✓✓
A