12-101067 t ... *Building 4 Commercial .
• City of Federal Way • ::, ¢-
Community&Econ.Dev.Services ' ""Zr) Permit #: 12-101067-00-CO
33325 8th Ave S ,',-
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2604.1-"4:41:4,....1--,,,, Inspection Request Line: (253)835-3050
Project Name: ST FRANCIS WEIGHT LOSS SURGERY CLINIC
Project Address: 34509 9TH AVE S Suite 203B Parcel Number: 750451 0010
Project Description: TI-Renovation of an existing outpatient medical suite for new tenant,work includes new
walls,some ceiling grid changes,demo of some existing walls,relocate some existing
lighting& mechanical,and new plumbing fixtures.
Owner Applicant Contractor Lender
ST FRANCIS MEDICAL CTR ASSO BUFFALO DESIGN JOHN KORSMO CONSTRUCTION -
1717 SOUTH J ST 1919 2ND AVE SUITE 200 INC
TACOMA WA SEATTLE WA 98101 JOHNKCI126BE(1/1/14)
98405 PO BOX 1377
TACOMA WA 98401
Census Category: 437- Commercial alt/add/conversion
Includes: #1 #2 #3 #4
Occupancy Class: 1-2
Construction Type: Type II-A
Occupancy Load:
Floor Area(sq.ft.) 1,915 0 0 0
Additional Permit Information
Existing Sprinkler System in Building? Yes Mechanical to be Included? Yes
Number of Stories 3 Permit for Building Shell Only? No
Plumbing to be Included? Yes New/Additional Sq.Feet-Total 0
Occupancy#1 -Use Hospital Zoning Designation OP
Mechanical Fixtures
Ducting 1
Plumbing Fixtures
Lavatories 3 Sinks 1 Water Closets 1
PERMIT EXPIRES Saturday, September 29, 2012
Permit Issued on Monday, April 2, 2012
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the u e will be in accordance with the -ws, rill-Aland. regulations of the State of Washington
and th City • ry.
Owner or agent: Date:
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City of Federal Way • •
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that
at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building
construction or use. This certificate is valid ONLY when endorsed by City staff.
Tenant Name: ST FRANCIS WEIGHT LOSS SURGERY CLINIC Permit#: 12-101067-00-CO
Address: 34509 9TH AVE S Suite203B
Includes: #1 #2 #3 #4
Occupancy Class: 1-2
Construction Type: Type II-A
Occupancy Load
Floor Area(sq.ft.) 1,915 0 0 0
Owner Name: ST FRANCIS MEDICAL CTR ASSO
Owner Address: 1717 SOUTH J ST
TACOMA WA
98405
Building Official Date
The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which
experience has shown most severly affect the health and safety of the general public. Although the City has made as complete a
review and inspection as is reasonably possible(within budgetary time and personnel limitations), the City neither guarantees nor
warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every
ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon
which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises.
• .
THIS CARD IS TO MAIN ON-SITE •
CITY OF Construction I ection Record .
Federal Way INSPECTION REQUE TS: (253)835-3050
•
PERMIT#: 12-101067-00-CO Address: 34509 9TH AVE S Suite 203B
Project: ST FRANCIS MEDICAL CTR ASSO FEDERAL WAY, WA 98003
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.
SWM Precon Site Mtg(4400) Initial Erosion Control(4365) Footings/Setback(4110)
Approved To be done prior to breaking ground Approved to place concrete
By Date By Date By Date
Re-steel(4215) Plumbing Groundwork(4190) Slab/Concrete Floor(4255)
Approved to place concrete or grout Approved to cover Approved to place concrete
By Date By Date El
By Date
Underfloor Framing(4285) Floor Sheathing(4105) Rough Plumbing(4230)
Approved to sheath floor Approved to install flooring Approved
By Date By Date By G Date
Mechanical Rough-in(4165) Gas Piping(4125) Fire/Draft Stops(4095)
Approved Approved to release test Approved
By Date By Date El
By Date
El Interim Erosion Control(4370) schedFraming to scheduling a Framing inspection; ( )
Approved Electrical,Plumbing&Mechanical Rough-in and Approved to insulate
Fire/Draft Stop inspections must be signed-off and
By Date approved. IBC 1093.4 By JGs Dat ij.—�Z
Insulation(4150) Gypsum Wallboard Nailing(4130) Suspended Ceiling Grid (4265)
Approved to install wallboard Approved to install mud&tape Approved to drop tile
By Date By�'CS Date �zt -� By-CS Date
El Final-Fire Department(4060) Final-Planning Final Erosion Control(4375)
El
Approved Approved Approved
By Date By Date By Date
0 Final-Mechanical(4065) ❑ Final-Plumbing(4075) Final-Building(4050)
Approved Approved Approved
By Date B Dates', ---1,.,�Z Bytes Date._S /Z
Rough Electrical Final Electrical Right of Way
Approved Approved Approved
B Date (� By Date By Date
AB
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COMMUN1 DE* v, R $ 2012 ABPLICATION 3
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253-835-2607•FAX 2 int: 26 9
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SITEADDRESS St. Ggiicis Medical Office Building SUITE/UNIT#
34509 9th Avenue S, Federal Way 98003 203B
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 80, 000 OP 7 5 0 4 5 1 0 0 1 0
TYPE OF PERMIT BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT St . Francis Weight Loss Surgery Clinic
(Tenant Name/Homeowner Last Name)
Renovation of an existing outpatient medical suite to
PROJECT DESCRIPTION suit new outpatient medical tenant.
Detailed description of work to
be included on this permit only
NAME PRIMARY
PROPERTY OWNER Franciscan Health System 28 426 4343
aAIUNG ADDRESS 1717 South J Street E-MAIL
johnelswick®fhshealth.org
CITY STATE ZIP
Tacoma WA 98401-2197
, j/ NAME PHONE
"' MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME Buffalo Design - architect PHONE0467 6306
APPLICANT MAILI
G ADDRESS1919 Second Ave. suite 200 E-MAIL
julia@buffalodesign.com
CITY STATE ZIP FAX
Seattle WA 98101 206 624 1494
PROJECT CONTACT • miim Julia Cygan, project manager PHONE
(The individual to receive and
respond to all correspondence MAILINGADDRESS Buffalo Design, above E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING mum
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.
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 ou the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to itgas partis application.
SIGNATURE: - DATE
3/7/2012
ris Carlson, principal, Buffalo Design
PRINT NAME:
Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
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( ALU(- E of MECHANICAL WORK $ (a copy of bid or es •, .to must be provided)
Indicate how .1 1 . -or •. . . :. .. - : - • - . . -- -.. :.. • 3 is project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commerciel) Relocation of
BOILERS FURNACES HOT WATER TANKS(Gas) existing supplies
COMPRESSORS GAS LOG SETS REFRIGERATION SYST and returns only.
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of fvx-ture to be installed or relocated as part of this project. Do not include existing f aures to remain.
BATHTUBS(or Tub/shower Combo) 3 LAVS(nand sinks) 1 TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS 1 SINKS(Kitchen/utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES 5 TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
No 1 -(i(,() V�b 80, 000 . 00
RESTING! USE LOT SIZE(In uare Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPR�ESSII SYSTEM?
LVA(j9Ocot X Yes ❑ No ❑Yes CYNo
',,'iii _ i ' �
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE 0 CARPORT 0
OTHER(describe)
ISEISTING PROPOSED
Area Totals 'O'"`
•IVEW' osis
•TED SELLING PRICE$ qq #OF BEDROOMS
DESCRIPTI•-` Area Occu.. .cy Group(s) Co ' c #of Ad. f on . Information
Square Feet Type Stories
1 1 9 R
AD 1ITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL � ��i ({21
T1 5
'TENANT AREA ONLY 1, 915 sf B II A 3
PROJECT AREA ONIX t(
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application