08-103352 w. City af#�deral W y • Mechanical Permits 08-103352-00-ME
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: ST FRANCIS MEDICAL PAVILLION
Project Address: 34503 9TH AVE S i= LParcel Number: 750451 0050
Project Description: Ductwork-grilles for existing VAV box
Owner Applicant Contractor
WSC MEDPAV LLC EMERALD AIRE INC(GENERAL) EMERALD AIRE INC(GENERAL)
1700 7TH AVE SUITE 1800 5108"D"ST NW EMERAAI055BL(04/01/09)
SEATTLE WA 98101 AUBURN WA 98001 5108"D"ST NW
AUBURN WA 98001
Additional Permit Information
Mechanical Valuation 1500 Is this an Online or O.T.C.application? Yes
Mechanical Fixtures
Ducts
PERMIT EXPIRES Tuesday, January 6, 2009
Permit Issued on.Thursday, July 10, 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 h the laws,rules and regulations of the State of Washington
and the witCity of federal Way.
Owner or agent:
Date: Cr`
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THIS CARD IS TOAIN ON-SITE.
CITY at. " ... Y pInspection Pommunit Develo me t Ins Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-103352-00-ME
Owner: WSC MEDPAV LLC
Address: 34503 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.
0 Mechanical Rough-in(4165) ❑ Gas Piping(4125) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By G LAD Date g_iT-v 6 .
cnT,,,A 110C- _1_0 5 5:fa
Federal Way RECEPApERM IT SF MF CO i EL PL DE EN FP
COMMUNITY DEVELO8 EVT SERVICES
33325 fSOUTH
98063-]8971
8
RAXWAY • J U L 10 AI'A p L I C AT I O N
253-835-2607•FAX 253-835-2609 / /
yvww.atuoftederalwauu.(.com
DE
The ollowin' icjJe.u reelg aatiO RAL WAYlete a••lication Will not be acce•ted. Please •;int le.Lb/ in in or •e.
MI PROPERTY INFORMATION
! t •
SITE ADDRESS 3"{ `5 Ave� �J /� C, cD SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 1 6 0 4 5.. ' - -LLOT SIZE(sj9
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING ya,MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT, � DESCRIPTION(Provide-detailed description of work included on thhissppermit onlu)
c -Lt e i ..C' 1. rt...ui-j 6ord.�1 et - -6 Vaca-•f..) bey
1ST 1 /te) ac cneE.lG
PROJECT NAME(Name of Business or Owner Last Name) fk-eu)CJ-5 intor, I > c
• PEOPLE INFORMATION
PROPERTY NAME• PRIMARY PHONE
OWNER rifled(��J ( �"• ) -
MAIL-INGADDRESS CITY,STATE,ZIP
11 vc, , 9601
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
gi'1iGr ci. Aro ids., ,S ,ivion ,' i:,!cs-t-xt ) 8`7a, -0-063
MAILING ADDRESS CITY,STATE,ZIP \c.1. CELL PHONE
>aae t ( u., n I &\ ( - ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATEFAX NUMBER
1 .-°113---1- Q 1 4 B L 1 C)4`.// 3l / U F ell)%-Ya ")
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
m& d a t✓e I ti (Sha. nun f ri4►1txi�^ i(0255) g13 fir%r
MAILING ADDRESS CITY,STATE,ZIP / CELL PHONE
5'oE 0 Si- t ar it ff g5 3 �)`�. ( ) ..._ -
RELATIONSHIP TO PROJECT
+, FAX NUMBER
0 Architect 0 Tenant 0 Agent /Other(Describe) n1IaG-bI " ( )g
' -579e-7
CONTACT PRIMARY PHONE E-MAIL ADDRESS
LENDER \ t.\ Cf(ic(
��q7l \ \ � 'u;A�4L.
Tu ° •' 5. '" � ' ; � E
, ,,a . x ' s . ieds 5QOc —
, . \SfKilar trta
ffd
MAILING
ADDRESS CITY,STATE,ZIP
■ DETAILED.BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS EXIST= PROPOSED rovu sorwsagmposP `t for yyaorosspu rare sr
NEW HOMES ONLY** NUMBER 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 (V)
Value of Mechanical Work $ I,7 U C)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
I DUCTS GAS PIPE OUTLETS
PLUMBING •
BATHTUBS(mrsb/sbowerc.mbo) _ SHOWERS WATER CLOSETS crone) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER$YST
WASHING MACHINES URINALS HOSE BIBBS
LAVS web.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 reli 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 DATE fl 1 C) y
(Signatu (Title)
RELATIONSHIP TO PROJECT 0 wner 0 Agent 0 Contractor 0 Architect 0 Other
❑NEW o ADDITION [t ALTERATION a REPAID O TENANTIMPRO EMENT
BUILDINGSHELL ONLY?.. `a YES;:a NO BASIC FLAP[?' i iI YES o NO
ZONING:DESIGNAT`ION ?r, r�s _,t]
NEVA ADDRESS REQUIRED? ca r n NO '" to j CHANGE BD SE` `k ,. Y` ifl T'I'TS o NO
•� .. .:. F ��.�-�'Q�s.I,,RF,» �+-nn{�t4�a�`.:L3�f t�•O NO :' i r
Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application