08-100025 •
City of Federal Way Mechanical Permit #•8-100025-00-M
Community Development Services •
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: CHILDREN'S HOSPITAL-X-RAY
Project Address: 34503 9TH AVE S Suite 300 ��, s Pa 1 N er: 750- 0050
Project Description: Installation of(1)new fan powered VAV box for the fedi 'c to - • control 6 new X- ;y
table with associated ductwork.
Owner Applicant Contracto
MEDICAL REAL ESTATE SERVICES,LLC HERMANSON CORPORATION HE'. '%NSON C• 'ORATION
105 CENTRAL WAY SUITE 203 1221 2ND AVE N "*1 VE N
KIRKLAND WA 98033 KENT WA 98032 A 98032
Additional Pe formation t
Mechanical Valuation 1201 er the Cou Pe t No
Mec -- urea
Air Handling Units Ducts....
T - -IRE hursday ary 14, 2010
r on onday, January 14, 2008
I here rtify that :bove i ation is •rrect and that the construction on the above described property and
t pancy -nd t e accordance with the laws, rules and regulations of the State of Washington
and -•ty of Federal Way.
gent: 4/ O a,
Ammofifif
Date:
P1 ®
- THIS CARD IS T 'REMAIN ON-SITE
CITY OF ''\ . CommunityDevelopffent Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-100025-00-ME
Owner: MEDICAL REAL ESTATE SERVICES, LLC
Address: 34503 9TH AVE S Suite 300
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.
0 Mechanical Rough-in(4165) 0 Gas Piping(4125) Ei Final-Mechanical(4065)
Approved Approved to release test Approved
By.„ -a S Date /— By Date S Date z
•
For inspector reference only _ _
❑ Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
RECEAD
CITY OF 0E) i b_ z s
Federal Way JAN 0 3 zoos PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF C L PL DE EN FP
33325 3D6 AVENUE SOUTH•63 BOX 0718 ty , ,P LI CATI O N
FEDERAL WAY WA 98063- Y I I N G R ID / ZM
/ot
253 b352607 FAX 253-835- 00 8�)ILDING D
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
JJ�� 4-ve.PRsOPE.RTY INFORMATION
SITE ADDRESS ! 1T7 q '1 SUITE/UNIT# ��
ASSESSOR'S TAX/PARCEL# 15.04 5 I - a v 5 O LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
� - S • D.' ill . ' ' PLr' 2
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING XMECHANICAL
❑ DEMOLITION 0 ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DES RI I (Provide detail•• n description of work included • this •ermit o L %
- r Alt
‘,,eg-k:- r.o - 1 1 0 Ili I Attb .
!.
•T re'SSOrt !!cCQQrt1 ' 1 �i 1-1es - kt-4 t I k_ '1±C)/A)
•
PROJECT NAME(Name of Business or Owner Last Name) ( �� Chi rens ' \
• PEOPLE INFORMATION
PROPERTYE- IPRIMARY PHONE
OWNER ��\ `�, k1m&i I • ` )
MAILI DRESS • ;t91141M.
E-MAIL ADDRESS
POInj •
CONTRACTOR EANYNAME /�O APP ICA;NQME OFFICE PHONE _ J)
c)n
MAILING ADDR S '•^`\'��'' I • •' E. P C LL ON
Cal FEI7L�t.WAY BUSINESS LIG_ BER �� , IRA N `O� AX N BER -
'- u�-0—iic -SBL 31 ( )
`1 CONTRACTOR S REGISTRATION NUMBE EXP I TE E-MAIL ADDRESS
APPLICANT COMPANY NAME APP C T qE OFFICE ONE Wtr
ING AD RE • . CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant gent ❑ Other ( ) -
PROJECT NAME Co A PRIMARY PHONE E-MAIL ADDRESS
CONTACT {" ref; l( Ci/off- ( ) -
LENDER NAME I Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRES CITY, - v _ PHONE---`‘,.\. -
( ) �
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ E OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FI PPRESSIONSYSTEM PROPOSED/REQUIRED? o YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAV ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• •
• PROJECT FLOOR AREAS
AREA DESC ION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND N
THIRD ��
ADDITION FLOOR (DESCRIBE) -'`""
DECK(❑COVERED OR ❑UNCOVERED?) .
GARAGE ❑ CARPORT ❑ r "
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF.. TOTAL k'ROPOSED SF ' TOTAL SF
**NEW HOMES ONLY** NUpER 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$� (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 1 MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commet dal)
■�/ l( Q�`f
COMPRESSORS FURNACES RANGES Box
-( DUCTS GAS LOG SETS 'REFRIG.SYSTEMS
PLUMBING
BATHTUBS(o(n i/showoi combo) LAYS(Baltuoon„Sloks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS Foto)
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'responsthility 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 • •e reliance of the city, including its officers and employees, upon the accuracy of the information supplied to
the city as a p• t of thio_appiication.
SIGNATURE: �.� `I,►� �- DATE
Pr. el er and/or Authorized Agent
FOR OFFICE USE ONLY'.
c NEW ❑ADDITION c ALTERATION c REPAIR c TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES c NO BASIC PLAN? ❑YES c NO
ZONING DESIGNATION CHANGE OF USE? a YES a
NO
NEW ADDRESS REQUIRED? c YES n NO UP/SEPA/SU? n YES n NO
PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? ❑YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application