09-100072 `Electrical
CiDevelopment
Way
Services
Community •
4 of Perla #: 09-100072-00-EL
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection Request Line: (253)835-3050
Ph (253)835-2607 Fax:(253)835-2609
Project Name: VIRGINIA MASON MEDICAL CENTER- ORTHO CLINIC
Project Address: 33501 1ST WAY S Suite 220 Parcel Number: 926504 0010
Project Description: Electrical TI for Ortho clinic
Owner Applicant Contractor
VIRGINIA MASON CLINIC H&M ELECTRIC INC H&M ELECTRIC INC
1100 9TH AVE PO BOX 799 HMELEI*077KR(5/19/09)
SEATTLE WA 98101-2756 MARYSVILLE WA 98270 PO BOX 799
MARYSVILLE WA 98270
Service greater than 1000 Amps9 No
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Circuits-Commercial 18
PERMIT EXPIRES Friday, January 8, 2010
Permit Issued on Thursday,January 8,2009
I hereby certify that theabove 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
nd the City of Federal Way.
Owner or agent: Date: t . 0 S
FINALE
D
0
CI
Alb, THIS CARD IS TO EMAIN ON-SITE, •
CITY OF kommunity DevelopnWnt Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 09-100072-00-EL
Owner: VIRGINIA MASON CLINIC
Address: 33501 1ST WAY S Suite 220
FEDERAL WAY, WA 98003
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.
❑ UFER Ground (4295) ❑ Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
❑ Pool Bonding(4195) ❑ Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
•
❑ Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date I75 Date c ,— /j By Date 414'Z
0 Final-Electrical(4055)
Approved
By Date
4. c-''7"
.
•
For inspector reference only
O Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
EcEiii.
ED
cnr� `SAN 0 8 20no !1 - Q a Z
Federal l SERVICES
� PERMIT
COMMUNITY DEVELOPMENT SERVICED PES SF MF CO ME Q PL DE EN FP
33325 6DTr AVENUE SOUTH•PO BOX 9718 CDS A I ' CATI O N
FEDERAL WAY,WA 98063-97]8 � TD
253-835-2607•FAX 253-835-2609
www.cltuoffederrdwml.corn
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
■ PROPERTY INFORMATION /�
SITE ADDRESS- 33501 1st Way South Second Floor NE Side SUITE/UNIT#- aA 0
ASSESSOR'S TAX/PARCEL# - LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ii ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
Tenant Improvement for Orthopedics clinic .
PROJECT NAME(Name of Business or Owner Last Name)
■ PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Virginia Mason ( 206) 341 - 0435
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
1100Ninth Avenue Seattle, WA 98101
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
H&M Rl eetri c' Tnc' Wayne Rrewster ( 360) 658 - 0501
MAILING ADDRESS CITY,STATE,tIP CELL PHONE
PC) Box 799 Marysvi 1 1 e WA 9R270 (260 )779 - 2'300
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
19-93-103797-00-BL 12-31-2008 ( 36d 658-0502
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
HMELEI*077KR 5 . 19 . 09 wayneb@hmelec .com
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Same AS Contractor ( ) -
MAILING ADDRESS Cnc,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant ❑Agent ❑ Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT Wayne Brewster (360}658-0501 wayneb@hmelec .com
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CnY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
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 offixture 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(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS 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 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. y�
SIGNATURE: Q f-I/�� DATE ( . Oar V c)
operty Owner an /or A_uthorizeTAgent
FOR OFFICE USE ONLY
❑NEW ❑ADDITION n ALTERATION n REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES n NO BASIC PLAN? n YES ❑NO
ZONING DESIGNATION CHANGE OF USE? n YES n NO
NEW ADDRESS REQUIRED? n YES ❑NO UP/SEPA/SU? ❑YES n NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—January 1,2009 Page 2 of 4 k\Handouts\Permit Application