08-105637 • 3uilding - Commercial
City of Federal Way Q
Community Development Services Permit #: 08-105637-00-CO
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: VIRGINIA MASON MEDICAL CENTER
Project Address: 33501 1ST WAY S Suite D-118 Parcel Number: 926504 0010
Project Description: TI-Tenant improvement for 143sgft office into ultrasound clinic room.Adding a sink,
casework and new finishes.Adding new sheet flooring and relocating an interior door.
Plumbing included.
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Owner Applicant Contractor Lender
VIRGINIA MASON CLINIC COLLINS WOERMAN G L Y CONSTRUCTION INC VIRGINIA MASON CLINIC
1100 9TH AVE 710 SECOND AVE SUITE 1400 GLYCOI*01809 (9/30/10) 1100 9TH AVE
SEATTLE WA 98101-2756 SEATTLE WA 98104-1710 PO BOX 6728 SEATTLE WA 98101-2756
BELLEVUE WA 98008-0728
Census Category: 437 - Commercial alt/ add/conversion
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type: Type V-A
Occupancy Load:
Floor Area(sq. ft.) 0 0 0 0
Additional Permit Info matiion Aly
Existing Sprinkler System in Building? Yes Mechanical to be Included9 No
Number of Stories 1 Permit for Building Shell Only? No '--'''
Plumbing to be Included? Yes New/Additional Sq.Feet-Total 0
Occupancy#1 -Use Hospital Sensitive Areas?(Wetlands/Slopes,etc) No
Zoning Designation OP
� r
Lavatories 1
PERMIT EXPIRES Wednesday, September 9, 2009
Permit Issued on Friday, March 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
L and theFederal Wa .
Owner or agent: ...._.--1-- -. ,VV — Date: %/
37cli `f7
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DATE INSPECTOR AREA AND TYPE OF INSPECTION
3 I O� Oy ) (gr.AK
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411/4. • THIS CARD IS T(EMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-105637-00-CO
Owner: VIRGINIA MASON CLINIC
Address: 33501 1ST WAYS Suite .D-118
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.
❑ Footings/Setback(4110) 0 Re-steel (4215) ❑ Plumbing Groundwork(4190)
Approved to place concrete Approved to place concrete or grout Approved to cover
By Date By Date By Date
- 0 Slab/Concrete Floor(4255) ❑ Underfloor Framing(4285) ❑ Floor Sheathing(4105)
Approved to place concrete Approved to sheath floor Approved to install flooring
By Date By Date By Date
❑ Rough Plumbing(4230) ❑ Fire/Draft Stops(4095) NOTE: Prior to scheduling a Framing(4120)
Approved Approved j 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 108.5.4
❑ Framing(4120) 0 Insulation (4150) ❑ Gypsum Wallboard Nailing(4130)
Approved to insulate Approved to install wallboard Approved to install mud&tape
By Date, /r,`l,� By Date By .._ Date3. cs-
❑ Suspended Ceiling Grid (4265) ❑ Final-Fire Department(4060) ❑ Final-Planning(4070)
Approved to drop tile Approved Approved
By Date By Date By Date
❑ Final-Plumbing(4075) ❑ Final-Building(4050) •
Approved Approved
By Date By G. Date 7-' -07
For inspector reference only
0 Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
Federal WaySF
PERMIT SF MFcp, E EL PL DE EN FP
COMMUNITYDEVELOPMENTSOUTH
ENT SERVICES
Np 1 Z0,$P P LI CATI O N TD
33325 8Th AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 ' V 51.. /
253-835-2607•FA� �60 D�
WWW.Ctil17•FA m i FEDERAL
M. W A
The following is required�tiof nn-an VinLcomplete application will not be accepted. Please print legibly(in ink)or type.
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�/ • PROPERTY INFORMATION
SITE ADDRESS_ 15() 1'tea',Y 1 S. 'f V( I c LAI/� SUITE/UNIT# 1)1/O
ASSESSOR'S TAX/PARCEL# '( Z 6 T 6 4 - O 6 1 O LOT SIZE(sj)
LorS 1,2 3bt$ ,4 5,4, $#7 weir eArIntS Irric�P�eiG Divlsroru Afvr1802 5
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) AiN rL N4 ee . , �rc 4.i/:, r rx ar ' MI Yet'vHlr Il io O PiATS1 P44'4.
(Attach separate page/or length!)legal description/
• PROJECT INFORMATION
TYPE OF PERMIT g BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
J"'7 4-IV r rPI Pt2eariv1 r ¢=02 ( 3 '• CWF(GE tit) TO Vi.1 2-A-�71Aj L> CZIIU/G / ONI-1.
`.DitOZ 4A C4Sctuo . Mn ,4J J WS/AS
AL 1v Gi tt:1 ri-t M VLJ 541- 7- V(COO1? /A.r; Mir) 2e-Loc4tz-iz.: pia ,
PROJECT NAME(Name of Business or Owner Last Name) V 1/L /t1I4 t1!l cJC N M()l C4 L- CtIU �Q.
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Nj1IZC 1IV14 M4�t3J et 0Atce Gl-iv ( 0) 34/ -64'),
MAILING ADDRESS CITY.STATE,ZIP E-MAIL ADDRESS
Melt sYoe 4-s f 1 i1 PO P 4100° )r -t-' -tx WA '1 IIf yeri.pleccevmmc.or_g
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
s2 s , ,� ffl�( „ (/ ( 2 Y 5- - `S`is7..
MAILIN ADDRESS ITY,STATE,ZIP CELL P'ONE
L'A/CIr- ) = =v L= 1�- filo_ v ). , q,i , (-,ZS�'"/ - 17
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION
DATE FAX NUMBER
CONTRACTOR' REGISTRATION GIf U ER�� E IRATIO ODOE E-MAIL ADDRESS
6 "C D /OD/ .3 a
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
eoLl-iN5W4Crer�14N la1VIN Orr- , Al (°Zo& ) Z45 - 74,1,'5
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
7SO VA? apt- sutra /400 se-m-1-u- w4 `U/d4 ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
tr Architect 0 Tenant ❑Agent ❑ Other ( ) -
PROJECT NAME / PRIMARY PHONE E-MAIL ADDRESS
CONTACT test .J Ofl1e +V (ZOo) z41,- 2o(PJJ e6-7-rt�,oN�CZL4IN5�tl
LENDER NAME Per RCW 19.27.095: COP"
ill(Lk.11314 PI LJ 1'1DtUi,t. C 4V12 Lender information is required if project value exceeds$5,000
ir ,ia,1 0,A. RECEItEn ! R - 05(p_
MAILING ADDRESS CITY.STATE,ZIP PHONE
'WM' 14843v r ( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE MD( C CON(C PROPOSED USE it eb(C4L CLI/WC
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 2,i, 000
SPRINKLERED BUILDING? N YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE D TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN o HIGHLINE ❑ PRIVATE(SEPTIC)
r„. MR
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ. FT.
BASEMENT ^
FIRST 43i i`to L I ( 1�
SECONDSig56 .
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS Z &i 7 40 0 I 741
**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 A
Value of Mechanical Work$ N/A (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 appli. n.
SIGNATURE: ' � DATE �/ Z(AA C
O
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
NEW ADDITION ALTERATION ! REPAIR TENANT IMPROVEMENT
BUILDING SHELL ONLY? YES 2 NO BASIC PLAN? YES -;NO
ZONING DESIGNATION CHANGE OF USE? YES ,NO
NEW ADDRESS REQUIRED? YES c NO UP/SEPA/SU? YES r-NO
PLATTED LOT? YES NO DEMO PERMIT REQUIRED? YES 7 NO
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