07-106915 i
Community
CityoeFederalDevelopment vices
Se Way • Plumbing Permit 07-106915-00-PL
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 Parcel Number: 750451 0050
Project Description: Relocate(1) sink on 3rd floor in room #330; x-ray work includes waste,vent, and water
piping;
•
Owner Applicant Contractor
MEDICAL REAL ESTATE SERVICES,LLC STEVE STIRRETT SELLEN CONSTRUCTION
105 CENTRAL WAY SUITE 203 STIRRETT JOHNSEN INC SELLEC*372ND(6/1/2009)
KIRKLAND WA 98033 5555 WESTGATE RD NW PO BOX 9970
SILVERDALE WA 98383 SEATTLE WA 98109
Plumbing Fixtures
Lavatories 1
PERMIT EXPIRES Saturday, December 26, 2009
Permit Issued on Thursday, December 27, 2007
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
and the City of Federal Way.
Owner or agent: _ See Application Date: SeeApplication
.DEC 2 72007 .DEC 272007
FIL:jFff,ALL-
• THIS CARD IS TO illWMAIN ON-SITE
CITY OF ommunity Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 8353050
PERMIT #: 07-106915-00-PL
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.
El Plumbing Groundwork(4190) Rough Plumbing(4230) Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date BDate 1, —1,L...,.05/ By Date
Final-Plumbing(4075)
Approved
Bye/ Date /-
For inspector reference only _
0 Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
". c
III
RECEIV�j
CITY OF .''` . RECEIVED4V--
5_
COMMUNITY
Federal Way COMMUNINDEVELOPMEtp �`
COMMUNITY DEVELOPMENT SERVICES DEC 2 7 SF MF CO ME EL.�L DE EN FP
333258mSOA 98063 BOX 9718 Li G CAP I CATI O N
FEDERAL WAY,WA 98063-9718 7D WAY / /
2538352607worm, FAX 253-835-2609uiLDINQ DEP
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The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
�
�•t PROPERTY INFORMATION r
id.
h-�
SITE ADDRESS_ L�f t,`S�3 AQE: SUITE/UNIT#33v
ASSESSOR'S TAX/PARCEL# ( 5 e) 4 5- 1 - D 0 c r- 444
,A LOT SIZE(sj)1 �/
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) ox) FILE C £!C 1 6 F FE E�At_ U,)P I
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING
PLUMBING 0 MECHANICAL
0 DEMOLITION ❑ ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROD CT DESCRIPTION (Provide detailed description of work included on this permit only)
ReLO0-1041-8. WOE-(6 SI Nil_ ON 3 FL.. ( N 1266w\33O X TAY
1 a.k W IDES LOAsT VCM' 1- LA-)P•-:M12- P(P/iJ
PROJECT NAME(Name of Business or Owner Last Name) C_i «-O c-E?J S ! Y P-6-1-6 QA--rig
NI PEOPLE INFORMATION
PROPERTY NAMEPRIMARY PHONE
OWNER IMeDICAL- k-C •L"`"-34\:--re: St�l� 0-1. 6960 ` '/C -8.2-/R
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
/CLc- C E7i1r-ei - u -AU iC w A 94E/23
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Et SiOFsilkN pit ibi (zsot\I ( ob ) ( 2. - 'l--y)0
MAILING DRESS CITY,STATE,ZIP CELL PHONF
j 0� ?0 1)X �1��7 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
te L,tc C 3`�Z N t(1 -I--a
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
si-kR_ r- -- 31-1,\Aeti 1liANe Aiw► LA ( 00 ) 3vS" -2DSO
MAILING ADDRESS CITY,STATE,ZIP C""• ncIONE
assn ti-&Aeb N(tA) si LveiaM t.E, IAJA '13u l ) _
RELATIONSHIP TO PROJECT FAx DI v,ABER
0 Architect 0 Tenant 0 Agent r`Other U r.a C-al i-TRAC i P (7j(oO)(Air - t g 3 2,
PROJECT NAME ��-- !'"" "^Y PHONE E-MAIL ADDRESS . ..
CONTACT 630_e •- ,IZ v ) ' j7( - Jvci(' jr.t5C ays.)1 'necii.eopp,
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE CJ PPay ,O_ rfl-MCY14_ e- k _.
PROPOSED USE " - ` Ci L}
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK *3) 1
SPRINKLERED BUILDING? a YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN a HIGHLINE ❑ TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE ❑ PRIVATE(SEPTIC)
V •
• PROJECT FLOOR AREAS
''(�'
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD J -: CP 3'7 2 "2_3 7
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOT AL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type offixture 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 MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Thb/Shower Combo) I 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 o his application. �J
SIGNATURE• DATE /z-/// �7
Property O d/or Authorized Agent
FOR OFFICE USE ONLY
o NEW o ADDITION ❑ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—August 16,2007 Page 2 of 4 k\Handouts\Permit Application