16-105788 .. .- Ali-
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D PERMIT APPLICATION
d /�/ PERMIT CENTER+33325 8th Avenue South+Federal Way,:WA 98003-6325
53
'd@�� Y M CITY OF'ESDERAj 1/1/AV 2 835-2607+FAX 253-835-2609+DermitcenterItcltvofedera1way.com
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CDS
Building.Permit#16-103141-00-CO
ID
PERMIT NUMBER I (Q :_ 1 ' S 75-- S--
5-- . . TARGET DATE
N
SITE ADDRESS BI/ITE/UNIT M
34503 9th Avenue South,Federal Way,WA 98003-8727
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL.II
$ 264,000 7 5 0 4 5 1 .. 0 o. . 5 0
TYPE OP PERMIT 0 BUILDING 0 PLUMBING I.MECHANICAI. 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME.OP PROJECT Federal Way Endoscopy Center
Installation of(10)02 Outlets;(2)CO2 Outlets;(6)Vacuum Outlets
PROJECT DESCRIPTION '
Detailed description of work to .
be included on this permit only
NAME PRIMARY PHONE
CHI Franciscan Health System 253-426-4101
PROPERTY OWNER. MAILING ADDRESS E-MAIL
623 Martin Luther King.Way
CITY STATE ZIP
Tacoma WA 98405 •
NAME PHONE/
StirrettJohnsen Inc. 360-692-6128
'
MAILING ADDRESS - E-MAIL
CONTRACTOR 5555 Westgate Road NW diane@sjimech.com
CITY STATE ZIP FAX
Silverdale WA 98383 360-698-1832
WA STATE CONTRACTOR'S LICENSE It EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE!
STIRRJ*281B6 05 /-01 /18 20-04-100200-00-BIS
RARE., t PHONE
SiPRrrett Johnsen Inc. 360
t 692-6128
APPLICANT MAILING ADDRESS E-MAIL
5555 Westgate Road NW diane@sjimech.com
CITY STATE ZIP FAX
Silverdale WA 98383 360-698-1832
. - - - NAME - PRIMARY PHONE
PROJECT CONTACT Diane Almojuela 360-308-2080
(The individual to receive and MAILING ADDRESS EMAIL
respond to all correspondence 5555 Westgate Road NW diane@sjimech.com
concerningthis application) CITY STATE ZIP. FAX
Silverdale WA . 98383 360-698-1832
NAME
PROJECT FINANCING 131 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RW19.27,0951
I certl)y under penalty 0f perjury that,1 am the property owner or authorised agent ofthe property owner.I certify that to the best
of my knowledge,the information:submitted in Support gf this permit application is true and correct.I certify that I will comply with.
all applicable City of Federal Wayregulations pertaining to the work Withoriaed: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.
Ifurther agree to hold harmless the City of Federal Way as to any claim(including coats,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 gf the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE: 4.02.izz.../ !' -.. K .z 4 DATE12/6/16
PRINT NAME:
Diane Almojuela
Bulletin X1100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
• 4
VALUE OFMECHANTCAL WORK
MECHANICAL PERMIT $ 5,000
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 1R , GAS PIPE OUTLETS(Medical) OTHER(Describe)
-
AIR CONDITIONER FIREPLACE INSERTS HOODS icomoscrcia)
BOILERS FURNACES HOT WATER TANKS(on.)
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.ct:this project.Do not include existing fixtures to remain.
BATHTUBS tor 7ub/s3wwsrCombo) LAVSOland Stoke) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Deserlbe)
DRAINS . SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS pUteben/UWRy) WATER HEATERS(Elates
HOSE BIBBS SUMPS WASHING MACHINES - TOTAL FIXTURES
• GENERAL INFORMATION
CRITICAL AREA'ON PROPERTY, WATER PURVEYOR SEWER PURVEYOR VALVE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In'quare Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes 0 No ❑Yes ❑ No
RESIDENTIAL -• NEW OR ADDITION •
AREA DESCRIPTION(in square feet) EXISTING PROPOSED. TOTAL FOR OFFICE USE
z
FIRST FLOOR(or Mobile Home) •
COVERED ENTRY
1-121'696-1
GARAGE 0 CARPORT 0
EXW WI. - -PROPOSED TOTAL
Area Totals
_ ■)nom
.`z:.E o.f T aL �v...:'-.�.�:.��"'s� '�.,.'�,�.r" ��iS�Y�•x�x'._ st" &-- �� 4`�::3e'?.�F�i'�`_�' �_,
ESTIMATED SELLING PRICE$ #OR BEDROOMS
COMMERCIAL—NEW/.ADDITION
AREA DESCRIPTION
Area in OccupancyGroupie) OMR St#ories of Additional Information
usre Feet
r �' - �5 z' k'' ., ! s s -Y"R'ix k;+:_'h'r<,s�,,
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Area in Construction #of Additional Information.
AREA DESCRIPTION Square Feet Oooupanoq Groupie) •a Stories ?j
,., S x F`� '"� � _ C',.� a��— �"-� =• "X' - Ski:-
.�a :0ljt" Vv �°*"„ ''+ '�� -"uv-.�."' � ° Y,' ZA
TENANT AREA ONL1t •
1F, `a-,; � .•c ae`�. '7 '3tt�:. `-"' -� ..'.� Est x # 7 ,'
v+.c� �•," .�� � g17 ' TF��._ t .�,.•. a ..1111A
•
Bulletin#100-January 29,2016 Page 2 of 2 . kalandouts\.PermltApplication