09-100129 0 • Mechinical
City of Federal Way Q
Community Development Services Permit #: 09-100129-00-ME
P.O.Box 9718 , ; -.1
Federal Way,WA 98063-9718 Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax (253)835-2609 1: p q
Project Name: VIRGINIA MASON MEDICAL CENTER-ORTHO CLINIC
Project Address: 33501 1ST WAY S Suite 220 Parcel Number: 926504 0010
Project Description: ALT-Install(5)VAVs,(1)exhaust fan,grilles,registers,diffusers,and modify existing
ductwork. Controls under separate permit.
,
Owner Applicant Contractor
VIRGINIA MASON CLINIC JOHANSEN MECHANICAL JOHANSEN MECHANICAL
1100 9TH AVE 20109 144TH AVE NE JOHANMI173PK(02/02/09)
SEATTLE WA 98101-2756 WOODINVILLE WA 98072 20109 144TH AVE NE
WOODINVILLE WA 98072
Mechanical Valuation 68983 Is this an Online or O.T.C.application? No
eee, pr t , 6 t eg a,7, 'y e ye ,\'‘
Air Handling Units 5 Ducting 1 Fans 1
PERMIT EXPIRES Wednesday, August 12, 2009
Permit Issued on Friday, February 13, 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
nd the City of Federal Way.
Owner or agent: l `_J Date: 1, i 4 o7
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DATEINSPECTOR AREA AND TYPE OF INSPECTION
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• THIS CARD IS T€MAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 09-100129-00-ME
Owner: VIRGINIA MASON CLINIC
Address: 33501 1ST WAYS 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.
E Mechanical Rough-in(4165) ❑ Gas Piping(4125) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By G,C� Date 4 By Date By C Ct.) Date 4. ZLl.0
• w
For inspector reference only
O Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
P ‘t,~oF CEI D - / a 0 / 2 g
Federal Way PERMIT
COMMUNITY DEVELOPMENTSERWWCES1�N 3 2oAPPLI
SF MF CO L PL DE EN FP
33325 FEDERALPH
SOUTH•63 BOX 9 CATI O N ZIFF
FEDERAL WAY,WA 98063-9718 7'D1 / / 0
253-835-2607*tuoi FA ,N5- 60$,F FEDERAL WAY
www.cituof'fed ral a c `�.J'•
The following is required Cation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
1 • PROPERTY/ INFORMATION
SITE ADDRESS_ 35 0 1 C-;t---6-4- ffU-L 1 St��-0^-- SUITE/UNIT#_
ASSESSOR'S TAX/PARCEL# 2 b S C) 4 - 0 C-) I C ) LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) U,(�,/ ; A 1 A cS c►'1 C_t i,Ait �.
(Attach eparate page for lengthy legal description)
IN PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onit)
l.s�01 I \ (5) VA J S . (i ) exp.� r-p --- CA r',1 Le_5 tRegi�CS i,I;c- s
Ccr-Vrcks tA^-a-C- 5-e_e.4-,LCS y:2-(i--„,,,.....\--
PROJECT NAME(Name of Business or Owner Last Name) V (j ., 1� 1�'` .cS 6✓j 0 r'T /r7 �k l C
IN PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER U, r I /c C.� M't.S U,' C t !a i C„_ ( ) -
MAILING DRESS CITY,STATE, IP E-MAIL ADDRESS
I1 0 9-N,— Av-e- Se_ez.( tL ,►�/ 9��u
CONTRACTOR C1OMPANY NAME APPLICANT/NAVE. OFFICE PHONE
-�1O�cl✓LC A/tip cot
( 1 ti1.� An( t (li2S ) y cc/ - 22 0 r.
MAILING ADDRESS CITY, ATE,ZIP . _ CELL PHGAiT.
(00 ,r
20 x o'31 I Li Li —Are 0-C
iA7 vv cll �r�R. h1,4 9
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
(Ci-011 1v '7 47 - ot) 3L t . /01 (12.5 ) Li - Gam,33
CONTRACTOR'S` REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
Jo0A0M. _I7 ? `G-- Z/Zic7 1
APPLICANT COMPANY NAME �( �A -- APPLICANT Na.....0 OFFICE PHONE
it`�=a`t✓�iC`Ck1 I.J Vct✓ ' (Lt2s ) S2"7 - l021.
MAILING ADDRESS CITY,STA ,ZIP , 1 CELL PHONE
2A2to°l ill'�.F`'-.4,re A)C 1JOi)(\O;ll,1 w4-g (i12 s) 32.6 - Y5 3S
RELATIONSHIP 10 PROJECT �C /� FAX NUMBER
L
❑ Architect ❑ Tenant 0 Agent TOther C,vt-Yr ,s-' (42.5) I-{Vo -(0l 5 3
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT tV1 1/ (t 'is) 5 2.--) I JZ� v �iJ�c�L,-S e✓��(L.c
LENDER NAME 1 Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION C
EXISTING USE !'-' -c ; C en..\ PROPOSED USE 5 CI f--..4.—
EXISTING ASSESSED/APPRAISED VALUE$ 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 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 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 ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**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.
MECHANICAL
Value of Mechanical Work$ 1r
0c ) 95'3 (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 5 escribe)
BOILERS FIREPLACE INSERTS HOODS(commercial) V AQ S
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. VI
SIGNATURE: DATE aI 0 9
'Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-January 1,2009 Page 2 of 4 k\Handouts\Permit Application