10-105337 uilding - Commercial,
City of Federal Way • e
Community&Econ.Dev.Services Permit #: 1 0-105337-00-CO
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253) 835-3050
Ph (253)835-2607 Fax (253)835-2609
Project Name: FRANCISCAN MEDICAL GROUP PHARMACY
Project Address: 30809 1ST AVE S Unit K Parcel Number: 072104 9244
Project Description: TI-Demolition of some interior, non-bearing walls, construction of new non-bearing walls,
minor lighting changes,and relocation of an existing sink. Ducting changes to be by
separate permit.
Owner Applicant Contractor Lender
CLIFF ROBERTSON JULIA CYGAN SHOT CONSTRUCTION
FRANCISCAN MEDICAL GROUP BUFFALO DESIGN SHOTCCL895NZ (8/9/13)
1149 MARKET ST 1919 SECOND AVE UNIT 200 PO BOX 2145
TACOMA WA 98402 SEATTLE WA 98122 BUCKLEY WA 98321
Census Category: 437 - Commercial alt/add/conversion
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq.ft.) 792 0 0 0
Additional Permittformation ,
Existing Sprinkler System in Building? No Mechanical to be Included? No
Number of Stories 1 Permit for Building Shell Only? No
Plumbing to be Included? Yes Zoning Designation PO
Plumbing Fixtures >
Sinks I
PERMIT EXPIRES Tuesday, July 3, 2012
Permit Issued on Thursday, January 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 ederal Way.
Owner or agent: , - ,,,,:„..--7-' Date: I ' ' /7-
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THIS CARD IS TO REMAIN ON-SITE
CITY OF '��� • Construction Ii ection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 10-105337-00-CO Address: 30809 1ST AVE S Unit K
Project: CLIFF ROBERTSON 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.
0 Footings/Setback(4110) Re-steel (4215) 0 Plumbing Groundwork(4190)
Approved to place concrete Approved to place concrete or grout Approved to cover
By Date By Date By Date
• •
0 Slab/Concrete Floor(4255) El
Underfloor Framing(4285) Floor Sheathing(4105)
Approved to place concrete Approved to sheath floor Approved to install flooring
By Date By Date By Date
0 Rough Plumbing(4230) El
Fire/Draft Stops(4095)
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
•
El Framing(4120) •0 Insulation (4150) ❑Gypsum Wallboard Nailing(4130)
Approved to insulate Approved to install wallboard Approved to install mud&tape
By7C Date I _ ( 0 _/Z By Date BQC S Date A — ( 2- 12_
lJ
0 Suspended Ceiling Grid (4265) ❑ Final-Fire Department(4060) Final-Plumbing(4075)
Approved to drop tile Approved Approved
By Date By Date B73 13_a?_.)
—/
,0 Final-Building (4050)
Approved
' Date 7'70_�>
❑ Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
1.
0 - LO 3
CITY OFA PERMIT RECE-N , ME PL DE EN FP
Federal Way u \
COMMUNITY DEVELOPMENT SERVICES APPLICATION :.A 11 2011 I s ' '
253-835-2607•FAX 253-835-2609
www.cauorrederalWau.com CITY OF FEDERAL WAYi in
SITE ADDRESS CDS SUITE/UNIT#
0 O 1 IsT Acv-' -,19vT i P D,r---/-1_, W/-`r lam; K
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ D, coo D _ I �i 7
TYPE OF PERMIT ❑' BUILDINGPLUMBING ❑ MECHANICAL
❑ DEMOLITION ?❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT (-771
(Tenant Name/Homeowner Last Name ) p1n f� / i l L C-L
PROJECT DESCRIPTION
F"-' 140\ iT1 DP0 F tj<ICy11 I61 orfI CPS
� TO i'
Detailed description of work to �1 kr+A PLG\. ' 4 OV 1'-T 1 01-1 v` F �,"l -
be included on this permit only r,`I M iLr e,r- •
NAME PRIMARY PHONE
PROPERTY OWNER f'r-t+X 19�/l,)-1 N �T+t c-7'f` , '7 r73• .12V( 10
MAILIIYrADDRESS / -\11 E-MAIL
CITY STATE ZIP
TPCoM A. W f. li bko 1 , (e.f
cetif
NAME N DT `C T/.� C L ✓�W./L /" N PHONE+
CONTRACTOR NrDADDREs�t�[ 7 ) kl e.7N-CYFCe FSI 1'W . CA-5"1'•
CITztr, cLASTAT ZI. �r 3 3�' FAX
CO
WA STATE NTRCTOR'S CAA CENSE# 1v,��}1- EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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NAMPHONE
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APPLICANT MAILING ADDRESS - E-MAIL
MI 61 sEGo H1). A.,U , i '`U rtv�
k a) �7tAl CCA h,
CITY st-i-v•v STATE ZIP15 122.
5122. O 101-
14k14 6°v"PROJECT CONTACT NAME /� PHONE
(The individual to receive and f'`I` 1 kS G $ -r
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
� n 1:1 Required value of$5,000 or more
>�NGIS6/$ I'k �vllk ,5,1,5 N1 OWNER-FINANCED
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP 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
information supplied to the city as a part of this application.
SIGNATURE: OI/✓` DATE I2. ZZ• 701 d
PRINT NAME: ilwv,, ,•Ar VI !'S \f461 k+-1
Bulletin#100—April 14,2010 Page 1 of 3 k:AHandouts\Permit Application
• •
MECHANICAL FIXTURES, 41 =--'=-
VALUE OF MECHANICAL WORK $ _ ^(a copyio s + i--; ate must be provided)
Indicate how many of each type o re to be ' it ot<4"le •. ...Part of this project Do not include existing fixtures to remain.
AIR HANDLING UNITS / 204 «% GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER /- i 'LACE INSERTS HOODS(commercial)
BOILERS ' RNACES HOT WATER TANKS(Gas)
COMPRES e- GAS LOG SETS REFRIGERATION SYST
D G GAS PIPING WOODSTOVES
PLUMBING FIXTURES
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'Nb/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS -rSINKS(Kitchen/Utility) WATER HEATERS(Electr)c)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
t
$
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
o'Yes 2 No 2 Yes T No
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 ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES 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 BUILDING
TENANT AREA ONLY 1 j a
PROJECT AREA ONLY 1 61 Z \i'
Bulletin#100—April 14,2010 Page 2 of 3 k:\Handouts\Permit Application