10-101643 QTY at: RECEIVER
/ C7 - IDI Co 43
Federal Way PERMIT — —
COMMUNITY DEVELOPMENT SERVICE APR 2 3 2010 SF MF CO ME EL PL DE EN�
3332E RALSOUTH•Po BOX9718 LI CATI O N
FEDERAL WAY,WA 98063.9718 ro / /
253-835-2607•FAX 25S-835-�s OF FEDER A
u__w_!Ic.rr gffe_de g.a 49,Co
CDS
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 34515 9th Avenue South SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 7 5 0 4 5 1 - 0 0 2 0 LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
MI PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL M Eb 6,16kS
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detniied description of work included on this permit onlu)
PROJECT NAME(Name of Business or Owner Last Name) ST. FRANCIS HOSPITAL — Iv V e —E l
II PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Franciscan Health System ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
1717 So. "J" St. Tacoma, WA 98405
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Stirrett Johnsen Inc. Diane Almojuela $60 )308 - 2080
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
5555 Westgate Road NW Silverdale, WA 98383 ( ) -
cm'OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
20-04-100200-00-BL 5/30/10 t60 )698-1832
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
STIRRJ*281B6 5/30/10 diane@sjimech.com
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
STIRRETT JOHNSEN INC. Diane Almojuela (360 ) 308-2-080
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
5555 Westgate Road NW Silverdale, WA 98383 (360 ) 308-2080
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant ❑Agent Other Mechanical Contractor (360 ) 698-L832
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT Sean Sullivan ( 360) 308-2071 sean@sjimech.com
LENDER NAME Per RCW 19.27.095:
N/A Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE Hospital PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
0 •
• PROJECT FLOOR AREAS
ti AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. Sg.FT. SQ.FT.
BASEMENT
FIRST
SECOND ` , U R S --P.---c1-1/
THIRD /V
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL=MG SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE. $
II FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project Do not include existing factures to remain.
MECHANICAL *I 1
Value of Mechanical Work$02 7 I s (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATl
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commerclaq
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or I b/snomer Combo) LAVS(Bathroom sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS pbneti
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that I am the property owneror 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. L+� J�
SIGNATURE: DATE _2)—/v
Property O d/or Authorized Agent
r d
FOR QFF,„ICE USE ONLY`
H...x. ar4., 44.M, , a .,... . .. ,... ... ,. . ...
a NEW a ADDITION ❑ALTERATION a REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES a NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application