11-101236Building - Commercial -
City of Federal Way
Community Development Services Permit #. 1 1 -101236-00-CO
P.O. Box 9718
Federal Way, WA 98063-9718 Line: Request Inspection Re
Ph: (253) 835-2607 Fax: (253) 835-2609 Ins p Q (253) 835-3050
Project Name: MEDICAL IMAGING ON FIRST
Project Address: 33915 1ST WAY S Suite 130
Parcel Number: 926504 0150
Project Description: TI - Reconfigure existing storage area to add ultrasound room, xray room, dressing room
and office. Mechanical and Plumbing on separate permits.
Owner
Applicant
Contractor
Lender
CUNA MUTUAL INVESTMENT
DIANE BARRINGER
MOUNTAIN CONSTRUCTION
5910 MINERAL PT RD
HELIX DESIGN GROUP
MOUNTCI179N2 (1/1/13)
MADISION WI 53705
6021 12TH ST E SUITE 201
7457 S MADISON ST
TACOMA WA 98424
TACOMA WA 98409
Census Category: 437 - Commercial alt / add / conversion
Includes:
#1 #2 #3 #4
Occupancy Class:
B
Construction Type:
Type II - A
Occu anc Load:
Floor Areas . ft.
3,670 0 0 0
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?.......................................No New / Additional Sq. Feet - Total..............:.........:. 0
Occupancy # 1 -Use ............................................... Clinic - Outpatient Zoning Designation..............................., ................OP
PERMIT EXPIRES Monday, December 19, 2011
Permit Issued on Wednesday, June 22, 2011
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: ' C Date: 'J i'Z —
C1W OF
4z�
Federal Way
1k
ADDRESS:
Building Division
33325 Eighth Avenue South
Federal Way, WA 98003-6325
Phone 253-835-2607 Fax 253-835-2609
CORRECTION NOTICE
-f— - A O�a� ol -5 -�
PERMIT#:� � " k 0, �G-- <'
IF YOU HAVE QUESTIONS CA z 3 835-
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE -INSPECTION. SEE BACK OF CARD
FOR DETAILS. NOTE: ELECTRICAL CORRECTIONS ARE REQUIRED TO BE MADE WITHIN 15 DAYS.
/0 -17 -
DATE
INSPECTOR
DO NOT REMOVE THIS NOTICE
Page 4 0f-
THIS CARD IS TO REMAIN ON-SITE
cr;y CW OZ& Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 11 -101236 -00 -CO Address: 33915 IST WAY S Suite 130
Project: CUNA MUTUAL INVESTMENT FEDERAL WAY, WA 98003
A
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.
11
SWM Precon Site Mtg (4400)
Initial Erosion Control (4365)
Final Erosion Control (4375)
Footings/Setback (4110)
Underfloor Framing (4285)
Approved
Approved to place concrete or grout
To be done prior to breaking ground
Approved to place concrete
Approved to place concrete
By
Date
By
Date
By
Date
11
Re -steel (4215)
Slab/Concrete Floor (4255)
Final Erosion Control (4375)
❑
Underfloor Framing (4285)
- Building (4050)
Approved to place concrete or grout
Approved
Approved to place concrete
By
Approved
Approved to sheath floor
By
Date
By
Date
By
Date
By
Date
Floor Sheathing (4105)
Fire/Draft Stops (4095)Interim
Erosion Control (4370)
Approved to install flooring
Approved
Approved
By
Date
By
Date
By
Date
Framing (4120)
Insulation (4150)
Prior to scheduling a Framing inspection;
Electrical, Plumbing & Mechanical Rough -in and
Approved to insulate
Approved to install wallboard
Fire/Draft Stop inspections must be signed -off and
approved. IBC 109.3.4
r
By
Dateq q _:
By
Date
Gypsum Wallboard Nailing (4130)
Approved to install mud & tape
By Date
Suspended Ceiling Grid (4265)
Approved to drop the
By Date
Final - Fire Department (4060)
Approved
By Date
El
Final - Planning
Final Erosion Control (4375)
E]Final
- Building (4050)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
El
Rough Electrical
Approved
Final Electrical
Approved
Right of Way-�
Approved
By
Date
By
Date
By
Date
-_suBMT-r-•rW'(I - !a _L 2 -alp
Federal Way ERMIT MF 0ME PL DE EN FP
COMMUMIYDEVELOPM=SER APR 01 29APPLI CATI O N S
� 253-835-2607• FAX 253-835-2609
2➢IAAA!, (7h'Of £'.fltCAjilKlt . OF FEDERAL WAY
CDS
SITE ADDRESSSUITE)/UNIT #
VAY sm
PROJECT VALUATION ZONING ASSESSOR'S TAR/PARCEL #
$ -7-71000. _' 6T�' I _. 2 _& G 0 - _L s c5
TYPE OF PERMIT
><bUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeoumer Last Name)
��jy /d/ I �,/ /►� _', r �jti 1IA r
' ' I �C•� ,\L ld'
PROJECT DESCRIPTION
Detailed description of work to
kan ) 1—b
Oro Am V L 1> WcoH —
b
be included on this permit only
b12�Ss 1 DP'1PEE ;OF gx nme_
PROPERTY OWNER
NAME PRIMARY PHONE
GVN A HOfVxe'
MA LING ADDRESS
E-MAIL
CITY STATE ZIP
' 5
NAROV .F�
WV
PHONE
3
MAILING ADDRESS
74-S-1 SOVER ` ` v Ar-A-soosr
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CONTRACTOR
CITY
GoM Pf
STATE
ZW
q
FAX
-�
WA STATE CONTRACTOR'S LICENSE #
40V NEC 1121 Z
EXPIRATION DATE
I i I i a
FEDERAL WAY BUSINESS LICENSE #
- 11121 -
NAME
1 -
ONE
2 D
DD
MAILIN2-IRESS
APPLICANT
CITY
TAg-gtj A
STATE ZIP
w 42A
FAX
690 2--Z- 1
PROJECT CONTACT
NAME
PHONE
(The individual to receive and
MAELING ADDRESS
E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZLP
FAX
ALTERNATE CONTA NAME:
PHONE
E-MAIL,
PROJECT FINANCING
value of $5,000 or more
(RCW 19.27.095)
NAME
WARequired
0 OWNER -FINANCED
MAILING ADD, CITY, STATE, ZIP w
�i- A,
PHONE
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
informat' lied to the city as a part of this application.
t
SIGNATURE? DATE 4-1-11
PRINT NAME: NCs
Bulletin #100 -January 1, 2011 Page 1 of 3 k:\Handouts\Permit Application
is
VALUE OF bhmuAwcAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type of fwture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial
BOILERS FURNACES HOT WATER TANKS (cast
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS (or rib/Shower combo) LAVS (stand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS (Hitchen/Utility) WATER HEATERS (Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FI%TURES
CRITICAL ARRAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
pye, rx i or P11,4> e, $
EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUAMMION SYSTEM?
�(rYes ❑ No El Yes �No
Bulletin #100 —January 1, 2011 Page 2 of 3 k:\Handouts\Pernut Application