17-105582 PERMIT APPLICATION
CITY OF
ede` n FIRE PERMIT CENTER+33325 8Ih Avenue South ra ��., M}03-6325
i ! 253-835-2607+FAX 253-835-2609+permitcentelracl •+. e.a .. .com
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NOV 172017
PERMIT NUMBER. _ I v S 5 �_ l TARGET DATE CITY OF FEDERAL W,
— — COMMUNfTY DEVELONME
SITE ADDRESS SUITE/UNIT#
501 S. 336th Street, Federal Way, 98003
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ Z / 000 9 2 6 4 8 0 _ 0 2 4 0
TYPE OF'PERMIT 0 BUILDING 0 PLUMBING MECHANICAL 0 DEMOLITION 0 ENGINEERING 'FIRE PREVENTION
NAME OF PROJECT NW ��Kidney Center Federal Way West-
Me,01 C G► cpiei✓� a "1�o r e l 011.1 ift J V1 ell 1
PROJECT DE$CRIPT_.... i .. . ,
Detailed description of work to �'
be included on this permit only la,
NAME PRIMARY PHONE
Randy Thompson RH Foundation Plaza Assoc. LLC 206-720-3765
PROPERTY OWNER MAILING ADDRESS_ E-MAIL
00 Broadway randy.thompson@nwkidney.org
CITY STATE ZIP
Seattle WA 98122
NAME PHONE
Stirrett Johnsen
MAILING ADDRESS E-MAIL
5555 Westgate Rd
CONTRACTOR
CITY STATE ZIP FAX
Silverdale WA 98383
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
STIRRJ*281B6 05/ 01/ 18 20-04-100200-00-BL
NAME PRIMARY PHONE
Melinda Monroe 360-308-2080
APPLICANT MAILING ADDRESS E-MAIL
5555 Westgate Road NW melinda.monroe@sjimech.com
CI STATE ZIP FAX
Silverdale WA 98383
NAME PRIMARY PHONE
PROJECT CONTACT Melinda Monroe
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 5555 Westgate Road NW melinda.monroe@sjimech.com
concerning this application) CITY STATE ZIP FAX
Silverdale WA 98383 360-698-1832
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
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 of this application.
SIGNATURE: � \-�J` DATE H I _•_ I
PRINT NAME: Melinda Monroe
Bulletin#100–January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
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VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $ 25,000
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS 8 GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commemiai(
BOILERS FURNACES HOT WATER TANKS(Gaa(
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
BATHTUBS(or Tub/shower Combo( LAVS(Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(xAchen/ussty( WATER HEATERS(ciectric(
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
NO Lakehaven Lakehaven $ 2,312,000
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Office Building 108,820 D Yes X No E Yes No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
fit', , .����
o .M--. :t. . . ...vu.
FIRST FLOOR(or Mobile Home)
COVERED ENTRY _-
GARAGE ❑ CARPORT ❑
F
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) MEIN #of Additional Information
3 uare Feet Stories
6
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION , EMI Occupancy Group(s) #of Additional Information
Stories
TENANT AREA ONLY 28,722
• •e
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application