15-100667 -911150
• • .5"- /0_ () 6 7
Federal
EIVED PERMIT SF MF CO ME PL DE EN FP
COMMUNITY DEVELOPMENIOQ;C4 1 21315 AP P LI CAT I O N
253-835-26070 FAX 253-84/5W9a•
u'm;i;ctt,;0ffederrahl'f,ri(MR
CITY OF FEDERAL WAY
SITE ADDRESS CDS SUITE/UNIT#
33501 1st Way South
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 4496.00 9 2 6 5 0 4 - 0 0 1 0
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION ❑ ENGINEERING t FIRE PREVENTION .`
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) Virginia Mason NAC Panel Add
PROJECT DESCRIPTION Provide (1) NAC Panel to help balance the load on A/V circuit.
Detailed description of work to Add (1) smoke detector to be mounted over panel. \\
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER Virginia Mason Clinic 253-874-1652
MAILING ADDRESS E-MAIL
33501 1st Way S.
CITY STATE ZIP
Federal Way WA 98003
NAMENE
Sasco Electric 425-806-8400
MAILING ADDRESS E-MAIL
16650 Woodinville-Redmond Road
CONTRACTOR
CITY STATE ZIP FAX
Woodinville WA 98072
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESSLICENt
SASCOE*051R6 12 / 26 15 601677475 Oo.i0� ' S'
NAME SimplexGrinnell PHONE 206-291-1400
APPLICANT
MAILING ADDRESS E-9520 10th Ave S, Suite 100 jastebbi�ns@simplexgrinnell.com
CITY STATE ZIP FAX
Seattle WA 98108 206-291-1500
PROJECTCONTACT NAME PHONE
Janet Stebbins 206-291-1468
(The individual to receive and
respond toall correspondence
MAILING 9520 10th Ave S, Suite 100 jastebbiinns@simplexgrinnell.com
conceming this application)/
CITY STATE ZIP FAX
'}) Seattle WA 98108 206-291-1500
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
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.
/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 assaapart of this application.
SIGNATURE: >i1�/LIf�//��f?/ U/Of I 6 b Ari 0 1 DATE 2/10/15
PRINTNAME: Janet Stebbins/SimplexGrinnell
Bulletin#100-January 1,2011 Page 1 of 3 k:\}Iandouts\Permit Application
110 •
MECHANICAL FIXTURES
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(orTob/shower Combo) LAVS(Hood Sinks) TOILE IS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility)SUMPS
WATER HEATERS(Eleanc)
HOSE BIBBS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT 0
OTHER(describe) t,
ERISTINO PROPOSED TOTAL
Area Totals
*'NEW HOMES ONLY"
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NiW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT Ii\IPROVEMENTS
AREA DESCRIPTION Square
In Area Feet Occupancy Group(s) Construction #of
Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 1,2011 Page 2 of 3 k:\Handouts\Permit Application