05-100567 • 0 , .-
City of Federal Way Building - Commercial Permit #: 05 - 100567 - 00 - CO
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection request line: (253) 835-3050
Ph:(253)835-7000 Fax:(253)835-2609 p q
Project Name: ST FRANCIS MOTHER/BABY WING
Project Address: 34515 9TH AVE S Parcel Number:750451 0020
Project Description: TI-Installation of fire rated door,partition wall,and associated mechanical work.No plumbing.
Owner Applicant Contractor Lender
FRANCISCAN HEALTH SYSTEM SELLEN CONSTRUCTION SELLEN CONSTRUCTION NONE
1717 S J ST PO BOX 9970 SELLEC*372NO 6/1/05
TACOMA WA 98405-4933 SEATTLE WA 98109 PO BOX 9970
SEATTLE WA 98109 NONE
Includes:
Census category: 437-Comm #1 #2 #3 #4
Occupancy Group: I-1.1
Construction Type: Type I-FR
Occupancy Load:
I-Floor Area(Sq.Ft.): 1200
Census Category 437-Commercial alt/add Mechanical Yes
Number of Stories 1 Permit for Building Shell Only No
Plumbing No
Mechanical Fixtures
= J� yl ; Description y —- ipt J
Description uantit Quandt 1 Description Quantity!
t. i
Air Handling Units 7 PDUcts 1
—- __- _r 11
PERMIT EXPIRES August 8,2005.
Permit issued on February 9,2005
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.
i
Owner or agent: Date: ,2/9/0 S
.
Ilk THIS CARD IS TOOEMAIN ON-SITE
CITY OF 3 �.ommunity Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-100567-00-CO
Owner:
Address: 34515 9TH AVE S
FEDERAL WAY, WA 98003-6761
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.
O Footings/Setback(4110) ❑ Foundation Wall (4115) ❑ Drainage/Downspout(4040)
Approved to place concrete Approved to place concrete Approved to backfill
By Date By Date By Date
❑ Re-steel(4215) ❑ Plumbing Groundwork(4190) 0 Slab/Concrete Floor (4255)
Approved to place concrete or grout Approved to cover Approved to place concrete
By Date By Date By Date
•
• Underfloor Framing(4285) .❑ Floor Sheathing(4105) 0 Shear Walls (4245)
Approved to sheath floor Approved to install flooring Approved to install siding
By Date By Date By Date
• •
❑ Roof Sheathing (4220) .❑ Mechanical Rough-in (4165) • �❑ Gas Piping(4125)
Approved to install roofing Approved Approved to release test
i By Date By Date 1 By Date
k
Fire/Draft Stops (4095) NOTE: Prior to scheduling a Framing(4120) Ii%
Framing(4120)
Approved inspection;Electrical,Plumbing&Mechanical Approved to insulate
Rough-in and Fire/Draft Stop inspections must be
B Date signed-off and approved. IBC 109.3.4/UBC 108.5.4 By NI v Date ��
y
1
,
❑ Insulation (4150) Gypsum Wallboard Nailing(4130) iTak Suspended Ceiling Grid (4265)
Approved to install wallboard ,Approved to install mud&tape Approved to drop tile
By Date Bye ACT Date 6, 10
.�� bb ,By .1 Date b5 zjt‘\?4
El Final-Fire Department(4060) .LI Final-Planning('070) • �❑ Final-Public Works (4080)
Approved Approved Approved
By Date By Date By Date
,� Final-Mechanical(4065) tea-- Final- Building(4050)
Approved Approved
la . $.
By ,``(11 i Date 06.- By A Date 3 ��(oç
CITY OF Ak RECO/ED • 05- / r C✓
Federal Way I
FFR SF M."a. EEL PL DE EN FP
PERMIT
COMMUNITY DEVELOPMENT SERVICES
33325 8m AVENUE SOUTH•PO BOX 9718 U Z�o
FEDERAL WAY,WA 98063-9718 LI C AT I 0 N TD / /
253-835-2607•FAX 253-835-2609 CITY OF FEEARPL A
www.cituoffederalwau.com
BUILDING DEPT.
The ollowi • is -'tared i ormatlon-an inco •lete a••lication will not be acce•ted. Please •rint le•ibl in in or .
Gj • PROPERTY INFORMATION
SITE ADDRESS 3 `a sem/5' / ,4.v� `f0 /4,4:96.4.4‹ a-?7 SUITE/UNIT# A-6° o�
ASSESSOR'S TAX/PARCEL# 7 r- O J--- / - U / / 0 ( LOT SIZE(si)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 's /,- F/ /,- -cT,ur ,e)J/F--,4--C
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING [MECHANICAL
❑ DEMOLITION 0 ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
jrJ7/f-H,17 1Of /9` O .8O0ti ,c i G2 -
kI,4- s47Oc y 7k.° ti 6ik- o/C6' o
02'•"- Ro,s,A.
PROJECT NAME(Name of Business or Owner Last Name) • 1 •-C2 tr Gfic-<CE
• PEOPLE INFORMATION
PROPERTY NAME� PRIMARY PHONE,
✓ /
OWNER , `/2r¢,--C2 J' # ' J 7?C_ Ip'f3 ) /ty - y///
MAILING ADDRESS '' CITY,STATE,ZIP
3 Y1-75' 9/4Ate,I- ssc7-f GE,o6 1".4-r 11-4, 7XO023
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
J 7/cam.••- Co...crf i.o(-r- //,�C y 1,--Te—ille- ( v6 ) /6orpt -�727o
M!^�IOL• 40)/S ” CITY,'7° fief'ISiEIZIP CELL k-A. /v/�1 67o` )NE
®fa. -7770
Y/��CIITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
old-vo -L o / yss-- BL i i6's- (aa3
06 ) i -J"c,2t6
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) .EXPIRATION DATE
J- E G L 6 G Z oZ .✓ u 6 / 07 / OJ
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
ST. fits!,.-c,F.r /Xdsr-riiK- C/fe i 0.>'‘,1-10.--7- 62r3 ) 7Y Y -y//(
MAILING ADDRESSCITY,STATE,ZIP (i,.,.4 CELL PHONE_
3�'ri 9� �J'a• Fi7 ei- k,r-7 yb'e,a. 3 (dry ) '799 -' ///
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant ❑Agent ❑ Other(Describe) 0 1-- ---if-A-- (an) ?ST -(e. //
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
C/-fCr" o rG/"1 t',-T ( 1r,3 )75,y - C//// c/i6r21,6.n�,,,re• cfrs wkrr.co.--r
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000 fY/iv d e'' /W/to.Ole /1o'00-z-71Ce-Z7.-rt
MAILING ADDRESS CITY,STATE,ZIP
�v GF••-®E--` -L.,vc2,7<yere
U DETAILED BUILDING INFORMATION
EXISTING USE H U J/-��A-L PROPOSED USE NV C//f..-- 6T
EXISTING ASSESSED/APPRAISED VALUE $ LC0/1'1 VALUE OF PROPOSED WORK $ /r/ a O b ,
Iv
SPRINKLERED BUILDING? AYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES ❑ NO
WATER SERVICE PROVIDER 1 LAKEHAVEN ❑ HIGHLINE 0 TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER tLAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
" /.,-',;,r." PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
6'---X,,T-r ( ..I 6- SQ. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND
Av erc,- d Ci_t cr//le2,-u•06 C /SV se Ft <?T ' () 7s „ft frr a c-eu
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS 4//1 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 $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES .2. MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS Ca AA-6 0.-",Fv✓6'4-4'
U Cl/F DUCTS GAS PIPE OUTLETS
PLUMBING N o Aif
BATHTUBS(or Tub/Shower combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way,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 application. / ))
NAME/TITLE / C: ^ a
DATE
(Sign ) (Title)
RELATIONSHIP TO PROJ f)wner 0 Agent 0 Contractor 0 Architect a Other
FOR OFFICE'USE ONLY
❑NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application