08-101035 4110 ,
City of Federal y r l P rmm#: 08-101035-00-E L
Community Developmentprem Services Electrical e
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: COMMUNITY HEALTH CENTERS OF KING COUNTY
Project Address: 33431 13TH PL S Parcel Number: 768190 0070
Project Description: Install low-voltage voice& data cabling for 350 square foot remodeled area.
Owner Applicant Contractor
KING COUNTY HEALTH INTERFACE TECHNOLOGIES NW INTERFACE TECHNOLOGIES NW
516 3RD AVE 4425 164TH ST SW INTERTN991J6(4/26/09)
SEATTLE WA 90104 LYNNWOOD WA 98087 4425 164TH ST SW
LYNNWOOD WA 98087
Additional Permit Information
Service greater than 1000 Amps? No
Electrical Fixtures
Low Voltage-Other Commercial.. 350
PERMIT EXPIRES Sunday, February 22, 2009
Permit Issued on Thursday, February 28, 2008
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: `^---�_ i �'—``- _ Date: ZS r�3 9
• � THIS CARD IS TO 'MAIN ON-SITE
CITY OF ' o" tY p Inspection 1)evelo m t Ins ection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-101035-00-EL
Owner: KING COUNTY HEALTH
Address: 33431 13TH PL S
FEDERAL WAY, WA 98003-6357
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 Slab/Concrete Floor(4255) ❑ Ditch cover(4030) ❑ Pool Bonding (4195)
Approved to place concrete Approved Approved
By Date By Date By Date
—t❑ Temporary Power (4275) ❑ Service(4235) ❑ Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
❑ Rough Electrical (4225) ❑ Ceiling Cover(4020) 0 Final -Electrical (4055)
Approved Approved Approved
By Date By Date By j n�, Date 0 9 O
cc� """°°°
❑ UFER Ground (4295)
Approved
By Date
For inspector reference only
0 Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
se ,
, ,
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0 3S
, "ry OF .E EI PERMIT
Federal Wa — — —
SF MF CO M D EL 'L DE EN FP
COMMUNITY DEVELOPMENT SERVICES
333258Th AVENUE SOUTH•POBOX 9718 FEB 2 8 ,';8PPLICATION
FEDERAL WAY,WA 98063-9718
253-835-26070 FAX 253-835-2609
www.cituoifederalw((a��u'�.(com p
f 9 '►�4 Q'i r bl A LnW
The ol[owin ut c�itt plete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS_ �t I (dq-121.5 ,1•5 , Oj �j 1 0 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 7 £ <3 / ! 0 - o C LOT SIZE (sfi
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 60WIAYILUI.(. , YI C 0- ell,l, 0d,
(Attach separate page for ngthy legal descrlptionl
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION IF'ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
1Ylil'L.t14a t, di (oiM Vb1 e, (OKlatt/Wu'ed 1yVI( 1,
PROJECT NAME(Name of Business or Owner Last Name) 1. 1\ I
• PEOPLEi INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY AME APPLICANT NAME OFFICE PHONE
i i1;1'1,�Ab--i 4'e (el,t h 4/DAA, 14an-le.e (. %o ) 8 -318 i
ti; I to�4�`` Si' ih{ CITY,
E
►�ioftwoct WA 0) °7 ( 421 )N•111-1 - I?✓'l 7
CITY OF FEDERAL WAY B SINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
'L0 ' oS - Ie Clcis , 00 fir i2I3(Iu (AV) ) `I'11 1 o
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION`DATE E-MAIL ADDRESS
(�11�(c.'(N�'lci 16(0 4' '.4210 9 �',addwP l piter etedinw.�c.n
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
lrnu.l�„i U ( 1 -1�,1r,� 1l1�Co A#xa ld e� >-�1 _(x'25)211 - I
LINGADD C TY,STATE,ZIP CELL PHONE
16 6 0 tee,t� S ua A4A1)4 , INA cto' i ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect p/I'enant o Agent o Other (425) 2,11 - I5(v
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT 1-0/1V, Wj eC4.14J1. (.2043) iiI i 9' - 6(Si yl -I'or.'ld441(R%iki.ei ce-igeh.IPJ,
LENDER NAME Per RCW 19.27.095: t"
ori
Lenderinformation is required(f project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 1
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE 0 PRIVATE(SEPTIC)
Mt
+-,> i III PRO CT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(LI COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
II 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 MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(BathroomSinkt) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(-roues)
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 t reliance of the city, including its officers and employees, upon the accuracy of the information supplied to
the city as a part of this appli t' .
n
SIGNATURE: 1 DATE /,7.5I4
Prop Owne and/or Authorized Agent
FOR OFFICE USE ONLY
❑NEW a ADDITION ❑ALTERATION ❑ REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application
1 ~ ellr S
•
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
❑ Single Family Square Feet Service or Feeder Each Add'n
(First 1300 ft2-$115.50;Each add'n 500 ft2-$37.00) U 0 to 100 amp $125.50 $76.50
❑ Detached outbuilding or garage ❑ 101 -200 amp 155.50 98.00
(Inspected with service) $48.50 ❑ 201 -400 amp 291.00 115.00
U Detached outbuilding or garage ❑ 401 -600 amp 339.50 136.00
(Inspected separately) $76.50 ❑ 601 -800 amp 439.00 186.00
❑ 801 - 1000 amp 536.50 224.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 584.50 311.50
Service Feeder
❑ Up to 200 amp $125.50 $37.00 ❑ Over 600 volts surcharge $98.00
❑ 201 -400 amp 155.50 76.50 ❑ Mast or meter repair $106.00
U 401 600 amp 212.50 106.00 ALTERED COMMERCIAL/INDUSTRIAL
U 601 -800 amp 272.00 145.50
❑ Over 800 amp 389.50 291.00 Service or Feeders
❑ 0 to 200 amp $125.50
ALTERED SINGLE/MULTI FAMILY U 201 - 600 amp 291.00
❑ 601 - 1000 amp 439.00
Service or Feeder ❑ over 1000 amp 489.00
❑ 0 to 200 amp $96.00
❑ 201 -600 amp 155.50 U #of circuits to be added/altered
U over 600 amp 234.00 (1-5 circuits-$98.00;Add'n circuits,$7.50/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$76.50;Add'n circuits$7.50/ea) $98.00 plus 35%of Permit Fee
❑ Service- 1,000 amps or greater
❑ Mast or meter repair $57.50 ❑ Medical/Educational/Institutional Facility
MANUFACTURED HOMES
U Service or feeder only $76.50
❑ Service and feeder $125.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/Multi-Family $67.50
❑ #of service or feeders
(First service/feeder-$76.50;each add'n-$50.00) Commercial/Industrial Service or Feeder Ampacity
❑ 0- 100 amps $76.50
❑ 101 -200 amps 98.00
❑ 201 -400 amps 115.00
❑ 401 -600 amps 155.50
❑ over 600 amps 168.00
MISCELLANEOUS SERVICE/EQUIPMENT
U #of Thermostats U #of Signs
(First-$57.50; add'n-$17.50/ea) (First sign-$57.50;add'n sign$27.00/ea)
U Low Voltage D U Swimming pool/hot tub $115.00
Square Feet to be served by system(s) (Includes additional circuit,if required)
❑ Fire Alarm System U Yard Pole meter loops $76.50
O Security Alarm System U Additional Plan Review $115.00/hour
JET Voice Cabling (for modified submittals)
fa Data Cabling U •
Automation Fee on all Permits .. $5.50
1st 2500 ft2-$67.50;
Each add'n 2500 ft2-$17.50) •Per WAC 296-46-91 0(5)(b)(i&ii)
Bulletin#100-January 1,2008 Page 3 of 4 k\Handouts\Permit Application