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09-101512 Plumbing City of Federal Way Community Development Services Permit #: 09-101512-00-PL P.O.Box 9718 Federal Way,WA 98063-9718 Ph (253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050 Project Name: ST FRANCIS HOSPITAL STAFF LOUNGE Project Address: 34515 9TH AVE S Parcel Number: 750451 0020 Project Description: Install(1)sink to remodel of staff lounge Owner Applicant Contractor FRANCISCAN HEALTH SYSTEM STIRRETT JOHNSEN INC STIRRETT JOHNSEN INC 34515 9TH AVE S 5555 WESTGATE RD NW STIRRJ*281B6(5/1/10) SEATTLE WA 98003 SILVERDALE WA 98383 5555 WESTGATE RD NW SILVERDALE WA 98383 Plumbing Fixture .4.2s Sinks 1 PERMIT EXPIRES Tuesday, October 20, 2009 Permit Issued on Thursday, April 23, 2009 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 thee State of Washington licatSee am id theWay o e Eion Owneroragent: Date: APR 2 3 2009 APR 2 3 2009 KIKatittogh CO(10/01 THIS CARD IS TO EMAIN ON-SITE CITY OF -' I/Community Developant nt Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT #: 09-101512-00-PL Owner: FRANCISCAN HEALTH SYSTEM Address: 34515 9TH AVE S FEDERAL WAY, WA 98003-6761 This card is part of your required inspection documents. 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. •E Plumbing Groundwork(4190) Ei Rough Plumbing(4230) El Gas Piping(4125) Approved to cover Approved Approved to release test By %% J Date By A By Date — 0 Final-Plumbing(4075) Approved By tAJ Date (P _l0• pcy. • For inspector reference only _ ❑ Rough Electrical 0 FINAL-Electrical Approved Approved By Date By Date 9/ 1 / , RECEIVED COMMUNITY DEVELOPME DEPARTMENT o / / CITY OF /) Federal Way APR 2 3 2009PERMIT SF MF CO ME EL.PL E EN FP COMMUNITY DEVELOPMENT SERVICES 3332ER SOUTH• BOX9718 Ap p LI CATI O N To FEDERAL L WA WAY.WA 98063-9718 / / 253-835-2607'FAX 253-835-2609 u_u!Ip_ttlo '_rl,raluxiy.p_rp The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION SITE ADDRESS 3T s I / A J ©U SUITE/UNIT#_ ASSESSOR'S TAX/PARCEL# 7 $ 0 5- '- D 0 0 LOT SIZE(s_f) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) El PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING PLUMBING 0 MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu) I K.)-%'11A1 ( 6/0 PROJECT NAME(Name of Business or Owner Last Name) �-- • PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER FaiWc! ) MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS h'711 -SO. .3" Si. ► 6KA OA- 7E-46-5- CONTRACTOR 5"CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE STI i'�2Li = -4 a l-iUs ti ) D 1 Pt?L l�L& E✓ (3t�O)3v� -2-On Ol� MAILING ADDRESS - CITY.STATE,ZIP CELL PHONE � �s' �J�-�-6 r� (�A Alu;�i�vr pay W/ q 73 ( ) COY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE MAIL ADDRESS s n R-(2--SL"17- /Je. s133/t .c APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE 511_ N- ) /iJ 0I 440 ft L Q Ul�tA ( 6c)) - MAILING ADDRESS COY,STATE,ZIPCELL PHONE Suess u.E 1— P.10 /JCL) 4r-AU`D r :-5( ) RELATIONSHIP TO PROJECT FAX NUMBER �i ❑ Architect ❑Tenant ❑Agent Other PLS B�-6Z (3(,Q ) 29g' -/b 3Z PROJECT NAME l I� PRIMARY PHONE E-MAIL ADDRESS CONTACT j�� C�-✓ l�L � ITS&) 136())36/t�j - � 7 LENDER NAME Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) • DETAILED BUILDING INFORMATION EXISTING USE R1 T ( � PROPOSED USE 3► �(`) P` EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) Y • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST TA FE l- 0 0 36 1 P P:o L.) -vik� SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(❑COVERED OR ❑UNCOVERED?) GARAGE ❑ CARPORT ❑ EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF NUMBER OF FLOORS **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE. $ • FIXTURES Indicate number of each type of facture to be installed or relocated as part of this project. Do not include existing fixtures to remain. MECHANICAL Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACE INSERTS HOODS(commerotan COMPRESSORS FURNACES RANGES DUCTS GAS LOG SEIS REFRIG.SYSTEMS PLUMBING BATHTUBS(or rub/Shower Combo) LAYS(Bathroom Sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS gone) ELECTRIC WATER HEATERS f 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 th' pplication. J ` � SIGNATURE: '^ '! j7 !, DATE —0Z `" Property Owner and/or A N.Nu: -d Agent FOR OFFICE USE ONLY ❑NEW n ADDITION o ALTERATION D REPAIR ❑TENANT DVIPROVEMENT BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? o YES ❑NO ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO NEW ADDRESS REQUIRED? n YES ❑NO UP/SEPA/SU? ❑YES o NO PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? o YES o NO t • Bulletin#100–August 16,2007 Page 2 of 4 k\Handouts\Permit Application