02-103306City ut Federal Way
Community Development Services Electrical Permit #: 02 -103306 - 00 - EL
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: ST FRANCIS HOSPITAL - AMBULATORY SERVICES BUILDING
Project Address: 34515 9TH S Parcel Number: 750451 0020
Project Description: ELE - Installing new IN cable TV wiring, including main distribution (backbone) and 24 cable outlets
for rooms/beds
Owner
Applicant
Contractor
ST FRANCIS MEDICAL
PRINCE TELECOM INC
PRINCE TELECOM INC
1717 S J ST
34 BLEVINS DR SUITE 5
34 BLEVINS DR SUITE 5
TACOMA WA
NEW CASTLE DE 19720
NEWCASTLE DE 19720
984054933
(253) 852-1569
Electrical Fixtures
CiP.SC[I flOjl� � .
Low Voltage - Other Commercial 57000
PERMIT EXPIRES January 28, 2003, IF NO WORK IS STARTED.
Permit issued on August 1, 2002
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 Wa
r /
Owner or agent: Date:$ / ^b Z
on
� �_ RECEIVED CONSTRUCTION PERMIT APPLICATI077-
f�YL AUG O 120PPLICATION NUMBER:
APPLICATION RUMBER:
CITY OF FEDERAL WAY APPLICATION NUMBER:
�Ii�G DEPT.
o — — — — - — —
lowing is required information — Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY INFORMATION
SITE ADDRESS:%�%� `� 9�� //ale 5• ASSESSOR'S TAX/PARCEL #: —
WA 9?acs
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
.,::..■ 'PROJECT INFORMATION-:.-.-
TYPE
NFORMATION -
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
,ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): o� Ca In(Q—�. u. .. Ti4r-1%jC'teS
A/n a/'s 4-ro1,,+cc -. Cmc IC bo (2� A,- -4 ZLf cablf— -"4k0-+C k r --. dr- 6-W
/i .1 VkNW% a hDi.l 11nMA , 53 Maf
PROJECT NAME: S4• nc S too --c:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
■ PEOPLE INFORMATION
NAME: L. DAYTIME PHONE:
J' '^
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
s'
Y S l 5- Al ,, -� � f�v�� � S . i=ce c.1c> - -. / C✓. V �%� 1 �c o
NAME:
-Pr'. V\Cj_- -Te- (e c
DAYTIME PHONE:
( 7S3 ) is 5- 2 -
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
(3-O3 5 Ce'Ar, ( 5 v A
( )s; -e^ --
CRY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
(Zs -3 ) 8SZ -Z3Z8
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
(copy or card required) 2 1 N C S o o t Q l
/! / 7-1 / Z cc. -2-
NAME: NAME:
MAILING ADDRESS
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
EXISTING USE:
PROPOSED USE:
■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
PROPOSED VALUATION FOR IMPROVEMENTS:
DAYTIME PHONE:
EVENING PHONE:
( )
FAX NUMBER:
E-MAIL ADDRESS:
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACE INSERTS) RANGE(S) MISC. { )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAINWATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. ( )
INTERCEPTORS) SUMP(S)
NTCCLSTMER%STGNOTHRE RLC
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 th� aias a part of this application.
NAME/TITLE: QL r DATE:
❑ PROPERTY OW ER ❑ APPLICANT CONTRACTOR
a COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • M-6661-4000 • FAX: 2S3-661-4129
www.dtvof federaIway.Com
- t -ELECTRICALTABLE B
NEW RESIDENTIAL SERVICES
MOBILE HOMES
MISC EQUIPMENT/TEMP SERVICES
Family .
_ Service or feeder only .........................
$50.00
_ # of Thermostats (First -537.50; add'n-$ 11.50ca)
-Single
(First 1300 ft' -$75.00; Each add'n 500 1`0424.00)
_ Service and feeder ...............................
S81.00
_ # of Low voltage fire or burglar alarms
Square Feet:
First 2500 ft' -$43.50- Each add'n 2500 ft' -$11.50
_Each outbuilding orgarage ...........................$31.00
MOBILE HOME/RV PARK
Square Feet: _
(inspected with service)
_ # of seryice or feeders
• Per WAC 29 -46-910(5)(b)(i & ii)
_ Each outbuilding or garage ...........................
$50.00
(First service/feeder-$50.00; Add'n service/
_ # of Signs (First sign -$37.50; add'n sign
(Inspected separately)
feeder -$32 each)
$17.50 each)
_ Swimming pool, hot tub, spa...............$75.00
Yard Pole meter loops .........................$50.00
NEW MULTI -FAMILY
COMMERCIAL/INDUSTRIAL
COMMERCIAL/INDUSTRIAL
(Includes three units or more)
Altered Service or Feeders
Service
Feeder
Amps Service or
Add'n
_ 0 to 200 ..............................................$ 81.00
_ Up to 200 amp .............. $ 81.00................
$ 24.00
Feeder_
201 -600 .............................................. 189.00
201 - 400 amp ................ 101.00....................
50.00
_0 to 100.........................$ 81.00.......
$ 50.00
_601- 1000............................................284.50
_ 401 - 600 amp ................ 138.00....................
68.50
_ 101-200 ........................ 101.00...........
63.50
-over 1000 ............................................. 317.00
_ 601 - 800 amp ................ 176.50....................
94.50
_ 201-400 ........................ 189.00...........
75.00
_ # of circuits
_ Over 800 amp ................. 252.50..................
189.00
_ 401-600 ........................ 220.50...........
88.50
(1-5 circuits -$63.50; Add'n circuits, $5 ea)
ALTERED SINGLE/MULTI FAMILY
601-800 ........................ 284.50.........
120.50
(When inspected separately from the services.)
_ 801-1000 ...................... 348.00.........
145.50
TEMPORARY SERVICE
Service or Feeder
-Over 1000 ...................... 379.00.........
202.50
Residential/Multi-Family/Coiiimercial/Industrial
_ 0 to 200 amp ...............................................
$ 68.50
_ Over 600 volts surcharge ......................
63.50
_ 0-100 ................................................ S 50.00
_ 201 - 600 am p ..............................................
101.00
_ Mast or meter repair-•--•---•-•-•- ................
68.50
_ 101 - 200.............. -----........---..................63.50
_ over 600 amp ................................................
151.50
_ 201-400 ................................................ 75.00
_ Mast or meter repair .......................................
37.50
_ 401-600 .............................................. 101.00
# of circuits
_ over 600 ...............................................109.00
(14 circuits -$50.00; Add'n circuits $5 ea)
I[ a new ut auctcu wuunc,cmt service is zvv amps or greater, or a new or aitered resiaenuai service is greater man vvv amps, a pian review is required. tee is 3�1 /o of
permit fee +$63.50. Add'I plan review for other submissions is $75.00/hr.
- FIXTUREDESCRIPTION (A) I FIXTURE FEE FROM TABLE B`(B) - >< NUMBER OF.UNITS',(C) 'TOTAL (D)
Estimated Permit Fee: (1
Total Column (D)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $63.50 + ( X .35) = (13)
DEMOLITION
Estimated Permit Fee: (14)
Bond Amount: (15)
N ENGINEERING
Estimated Permit Fee: (16)
G Bond Amount: (17)
EOTHER FEES
Mitigation Fee: (18) (20) (22)
SBCC Surcharge: (19) - (21) (23)
>rOtal (Pages one &Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) = (24)
Bulletin #100 - February 19, 2002