09-101256 Building - Commercial
City of Federal Way Q
Community Development Services Permit #: 09-101256-00-CO
f P.O.Box 9718
Federal Way,WA 98063-9718
Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax (253)835-2609 p q
Project Name: ST FRANCIS HOSPITAL STAFF LOUNGE
Project Address: 34515 9TH AVE S j,^ E N1¢✓5e vi,e Parcel Number: 750451 0020
Project Description: TI-Remodel of staff lounge'to include mechanical.IND plumbing on this permit.
Owner Applicant Contractor Lender
FRANCISCAN HEALTH SYSTEM HELIX DESIGN GROUP SELLEN CONSTRUCTION FRANCISCAN HEALTH SYSTEM
34515 9TH AVE S 6021 12TH ST E SUITE 201 SELLEC*372ND(6/1/09) 34515 9TH AVE S
SEATTLE WA 98003 TACOMA WA 98424 PO BOX 9970 SEATTLE WA 98003
SEATTLE WA 98109
Census Category: 437 - Commercial alt/add/conversion
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq.ft.) 0 0 0 0
New/Additional Sq.Feet- 1st Floor 0 Existing Sprinkler System in Building? Yes
Mechanical to be Included? Yes Number of Stories 3
Permit for Building Shell Only No Plumbing to be Included9 No
New/Additional Sq.Feet-Total 0
... . , 4 a Mechanical Fixtures
Ducting 1
PERMIT EXPIRES Wednesday, September 30, 2009
Permit Issued on Friday, April 3, 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 the State of Washington
a d t City offlFederal Way. J
Owner oragent: -C �j dj y v% '�U �� Date: �/ - j•
/ l
FINM44D /1Z/(314
THIS CARD IS TO REMAIN ON-SITE -
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 09-101256-00-CO
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.
•
0 Footings/Setback(4110) ❑ Re-steel (4215) ❑ Slab/Concrete Floor(4255)
Approved to place concrete Approved to place concrete or grout Approved to place concrete
By Date By Date By Date
- 0 Underfloor Framing(4285) f❑ Floor Sheathing(4105) 0 Mechanical Rough-in (4165)
Approved to sheath floor Approved to install flooring Approved
By Date By Date By Date
•
.❑ Gas Piping (4125) ❑ Fire/Draft Stops(4095) NOTE: Prior to scheduling a Framing(4120)
Approved to release test Approved i inspection;Electrical,Plumbing&Mechanical
Rough-in and Fire/Draft Stop inspections must be
By Date By Date signed-off and approved. IBC 109.3.4/UBC 108.3.4
,❑ Framing(4120) 0 Insulation (4150) ❑ Gypsum Wallboard Nailing(4130)
Approved to insulate Approved to install wallboard Approved to install mud&tape
By � 6-0 Date GJ-�--g By Date By . tj Date S-tZ�0,
• �
❑ Suspended Ceiling Grid (4265) ❑ Final-Fire Department(4060) ❑ Final-Planning(4070)
Approved to drop tile Approved Approved
By G GL) Date 4, - 3 .cos—, By y f Date Co -i/. O5 By Date
•❑ Final-Mechanical(4065) ❑ Final-Building(4050)
Approved Approved
By G j Date(. ti, D By Date 6- /2 - 04
.
For inspector reference only
0 Rough Electrical 0 FINAL-Electrical
Approved Approved •
By Date By Date
CITY OF Wn.,�.• lie 109,
'Federal Way -tI3/o� PERMIT
• COMMUNITY DEVELOPMENT SER I SF MF CO ME EL PL DE EN FP
.25
53-83b2 UEF 3 APPLICATION
�+ c
WWW.CIt .L. /
F Fi'^ 1�1'^►l
The following is requirdbnfQQrmation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
2 tlV17� p• PROPERTY INFORMATION
3
SITE ADDRESS 575 f�% '4 //r'e. SUITE/UNIT#
S
ASSESSOR'S TAX/PARCEL# " - v '7 57 - C)0 ZO LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Z/ T/^p4!//S 7 $ 7i,O1
/
(Attach separate page for lengthy legal description)
,
• PROJECT INFORMATION
TYPE OF PERMIT kBUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ;LECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlq) L
4.-0 /ovnyP - Ch0,7q �yT 077`/ c. fd li '�'P. ci_ pc:roe i
nn
exlsf:i [tea •• �Zb i't,P c.J
PROJECT NAME(Name of Business or Owner Last Name) Fg1 '"/c/..S �l l — STAFF—Witt
• PEOPLE INFORMATION
PROPERTY N PRIMARY PHONE
•'WNER Q/7.5/Ga'r'1 Titct/74 ,-:"/-574e '1'1 ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
& Sd/i OM.-ftica!/ C6nSf/UctO/"S nu 't/n'
a . !KO^ T tiIl (a5.3 ) 539 - 0.9 ,L G ADDRESS CITY,STATE,ZIP CELL PHONE
0 0 a. "3a,< "115,2,4 c 74 coiha. c.✓4 q$vww8' (z53) has- 75/3
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
0/'.• /02 5.4/ - 008 L /2. - 3, - X009' (z&J) 539- aid/
COPY of card required CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS .
with c application rlrt i6/1 C'0.15t�'r
Tl1 ' .-co 8C w 2., -/4 —2,0/ d d«.®fi4 P con,
APPLICANT CO PANY NAME APPLICANT NAME OFFICE PHONE
iCCANY AMA L l e c.-f/i c 4 / k.+S a.S?/.ktc/S ( )
MAILING ADDRESS �J R')C CITY,STATE,ZIP CELL PHONE
a?r tT AS /TBU/' ( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant fj Agent 0 Other ( ) -
PROJECT N L PRIMARY PHONE E-MAIL ADD S ro" 0'';
CONTACT rC�' d m�gc� ( ) 5�0�®f O�pza r1 eo.�sfi•c..orvk
LENDER NAME /�/ /� PerRCW 19.27.095:
/u$// Lender information is required if project value exceeds$5,000
MAILING ADDRES CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
•EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES ❑ NO
V
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ.FT.
BASEMENT
111,IRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOS® 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 fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHAIITICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLElb WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commermap
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
111 BATHTUBS(or Tub/Shower Combo)
DISHWASHERS
LAVS(Bathroom Sinks) URINALS MISC(Describe)
RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet(
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way,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. ,
NAME/TIT /,z:-e-- -at•e �/ 7�DATE -OP`200,
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner o Agent Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
•
Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application
r � (
CEINdEr .
CITY OF�./ �L
Federal Way APR 0 3 2009 — - 2 —j
PERMIT SF MF CO' ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
3332FEDERAL WA SWA ' 7 8970 F F E D E pEI C ATI O N
TD / ��C/
253-835-2607•FAX 253-835-2609
www.cituoffederalwau,Com CDS
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
A• PROPERTY INFORMATIONL
SITE ADDRESS 3 I SI'S" 1 i J AV 8 S. FG n Egp c tAlty 1/444 9 Sa1IITTE AIT#_
ASSESSOR'S TAX/PARCEL# i c o ( c i - Q _o LOT SIZE(s) Z3 S,7 /Q
0
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) S7. FgArqc IS H 6'p ITAG . BS P AS P Eg Z
:each •ate...efor S . _ r. .esaJES4 D ,EC zooio7z600/ 8513
■ PROJECT INFORMATION
TYPE OF PERMIT \a BUILDING 0 PLUMBING )(MECHANICAL
X.3EMOLITION 0 ELECTRICAL /❑`ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
lz-em opo- of FMPLoyE5 1TAlf LO') 496
PROJECT NAME(Name of Business or Owner Last Name) J i • F RANLi /1 c,. pi 7 p L : &. t). S 1Af f Lou Ni e
• PEOPLE INFORMATION
PROPERTY NAME �/ '` �1 r Mai
,,c ?y� PRIMARY PHONE
OWNER /2iGK 01,3 ON •S-1. FRANUJ /'1Wpi ! 4L (253) 142,64083S
MAILING ADDRESS ♦ CITY,STATE,ZIP E-MAIL ADDRESS
17,7s. 3 ' STizeeT TAconiA, AA 9bt/0c
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
S er,...Lp NI cokirTKvoT� unl �"ER tfl)P S Pk. pet4$4 L PZ)06 `i 217 of q
MAILING ADDRESS .(� f� �j CITY,STATE,ZIP W A 91 9 (`
H NE
ZZ-7 1N e5 / ~ `a Au
� SP/41TT� TION OATEN O " FAX NUM)ER
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPI
woo • / o i • 145'5. 00 e o b) 6z3 SZOto
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
SELLL c.*3? Z.IJo (o• I. 0 9
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
14eiJsxi D319N glzoup )e .`�I� M,,ARV ELJ, 2S3 ) 922- 9037
(Oo
MAILING
2.i ADDRESS
I2-?�ST. VAST ' Zol "TACO mA we, 9VlLi/ (ELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant ❑Agent X Other ES 9 N K- (ZS3) 9 22-Gil q 9
PROJECT NAME
C PRIMARY PHONE E-MAIL ADDRESS
CONTACT �73' G 1 1 WI ARV t (2.s3) 9 22- 9 037 f. .99,(M 6 h�.�l lk . )q n
LENDER ///NAME Per RCW 19.27.095: C1(0 U .cu.*
information is required if project value exceeds$ ,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
U DETAILED BUILDING INFORMATION ' t C ,/�
EXISTING USE ft 0 5 pi T A L PROPOSED USE 14 03 P 1 TA `—
EXISTING ASSESSED/APPRAISED VALUE$36 /67 SIS q0 0. 0OJALUE OF PROPOSED WORK $ 1 J�� 0 0 O
SPRINKLERED BUILDING? "[YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? \JYES ❑ NO p'
WATER SERVICE PROVIDER ,❑ \LAKEHAVEN o HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) W AT`2 i',S7FrCr
SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC) -- 71)86 (I
IIIII
•
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT /� r '` / �f -•)
FIRST S T ► 1 [_ `_ LA)L.1 0 4 % 7 7 7_ 1 7 !.+ l 7 Z
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL=STING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
■ FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL I `-7 7 S v
Value of Mechanical Work.$. j,.O n�..._( O_(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(commercial)
COMPRESSORS FURNACES RANGES
X DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sulks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Tot)et)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
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 Aft DATE 3• 3 ). 0 9
Pleli44 / 1f y er and/or Authorized Agent
FOR OFFICE USE ONLY
❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR D TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—January 1,2009 Page 2 of 4 k\Handouts\Permit Application