04-100322City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Mechanical Permit #:04 - 100322 - 00 - ME
Inspection request line: 253.835.3050
Project Name: ST FRANCIS HOSPITAL WOMEN'S HEALTH CENTER
Project Address: 34515 9TH -1 Pae S Parcel Number: 750451 0020
Project Description: Installation of dryer duct
Owner
Applicant
Contractor
Hospital Bsp StFrancis
STIRRETT JOHNSEN INC
STIRRETT JOHNSEN INC
2002 ADV DEP PD 5282869
STIRRETT JOHNSEN INC
STIRRETT JOHNSEN INC
5555 WESTGATE RD NW
5555 WESTGATE RD NW
SILVERDALE WA 98383
(360) 308-2080
Mechanical Valuation..........................................7942 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description�Quan itit Description Quantity Description' Quantity
Ducts
PERMIT EXPIRES July 26, 2004.
Permit issued on January 28, 2004
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use w' in ac.ordance with the laws, rules and regulations of the State of Washington and
the City of Federa ylj
Owner or agent: Date: l/Z�
Z — S — O-/ Lc.-,
3—Is-ve-lC \
a s I..-%./ I,,.. I M L— V
�r JAN 2 8 2004�C- 0
CONSTRUCTION PERMIT APPLICATION
CITY OF CITY OF FEDERAL WAY APPLICATION NUMBER: - Q Q _ -
QZ
Federal Way BUILDING DEPT, APPLICATION NUMBER: _ _ - _ _ _ _ _ _ - _ _
APPLICATION NUMBER: _ _ - _ _ _ _ _ _ -
**The following is required information - Please print (in ink) or type**
Please note: Electrical, Fre Prevention Systems and Engineering permits may require a separate application.
PROPERTY•• •
SITE ADDRESS: 34515 9th Avenue South ASSESSOR'S TAX/PARCEL #: 9 5 0 5 2 2- 1 0 4 3
LEGAL DffRIPION OSHBEP aRenAsHHlTeSeRIPTION IF LENGTHY):
aWett�omahCn
PROJECT•• •
TYPE OF PROJECT (This application): ❑ BUILDING QPLUMBING)ORE
i MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING PREVENTION SYSTEM
PROJECT NAME: St. Francis Hospital - Women's Health Center
PROJECT•• •
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
NAME: DAYTIME PHONE:
St. Francis Hospital ( ) -
MAILING ADDRESS (STREET ADDRESS; CrTY, STATE, ZIP):
34503 9th Avenue South #320, Federal Way, WA
NAME:
DAYTIME PHONE:
Stirrett Johnsen Inc.
(360) 308 -2080
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
5555 Westgate Road NW; Silverdale, WA 98383
( ) -
CM OF FEDERAL WAY BUSINESS LICENSE NUMBER:
0 4 _ 1 0 0 2 0 0 - 0 0
FAX NUMBER:
060 ) 698 -1
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
S T I R R J* 2 8 1 B 6
5 / 1
(copy of card required)
NAME: DAYTIME PHONE:
Stirrett Johnsen Inc. (360) 308 - 2080
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
5555 Westgate Road NW; Silverdale, WA 98383 ( ) -
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT MVTHER ( DESCRIBE): Contractor ( 360 ) 698 - 1832
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER NWPLICANT ❑ CONTRACTOR
PROJECT•• •
EXISTING USE: Hospital EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: Hospital _` PROPOSED VALUATION FOR IMPROVEMENTS: $ 19,476.00
SPRINKLERED BUILDING? �fES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRE&<�YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
—jr
81-
*NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIXTURES
Indicate number of each type of fixture
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
FIRST
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
AIR HANDLING UNIT(S)
SECOND
GAS LOG(S)
REFRIG. SYSTEMS)
BBQ(S)
THIRD
HOOD(S)
WOODSTOVE(S)
BOILERS)
FOURTH
RANGE(S)
MISC.( )
COMPRESSOR(S)
OTHER FLOORS (DESCRIBE)
DUCT(S)
DECK
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
GARAGE
HOW MANY FLOORS?
BATHTUB(S)
TOTAL:
URINAL(S)
WATER HEATER(S)
DISHWASHERS)
]TSCLAIMER/SIGNATURE BLC
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:
❑ PROPERTY OWNER ❑ APPLICANT
CAD nrmrr- I ICF nml V.
DATE: Z-Lezd 7
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
FIXTURES
Indicate number of each type of fixture
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
MECHANICAL
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEMS)
BBQ(S)
FAN(S)
HOOD(S)
WOODSTOVE(S)
BOILERS)
FIREPLACEINSERT(S)
RANGE(S)
MISC.( )
COMPRESSOR(S)
FURNACE(S)
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S)
I LAVATORY(S)
URINAL(S)
WATER HEATER(S)
DISHWASHERS)
RAIN WATER SYS. —7—WASH
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
SHOWER(S) MACHINE OUTLET
GAS PIPE OUTLET(S)
—T SINKS)
WATER CLOSET(S)
MISC. ( )
INTERCEPTORS)
SUMP(S)
]TSCLAIMER/SIGNATURE BLC
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:
❑ PROPERTY OWNER ❑ APPLICANT
CAD nrmrr- I ICF nml V.
DATE: Z-Lezd 7
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.cltvoffederalway.com