07-10514940-ity of Federal Way ~
Community Development Services Electrical Permit #: 07 -105149 -00 -EL
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: PACIFIC MEDICAL CENTER
Project Address: 33501 1ST WAYS
Parcel Number: 926504 0010
Project Description: Adding (1) circuit for corridor
Owner
Applicant
Contractor
VIRGINIA MASON MEDICAL CENTER
KEN BOBKO ELECTRIC CO INC
KEN BOBKO ELECTRIC CO INC
1100 9TH AVE
PO BOX 7009
KENBOECO66BA 1/1/08
SEATTLE WA 98101-2756
TACOMA WA 98406-0009
PO BOX 7009
TACOMA WA 98406-0009
Additional Permit lnforrntion
Service greater than 1000 Amps?...........................No
Electrical Fixtures
Circuits - Commercial ................... 1
PERMIT EXPIRES Mo
P"kUsued on FHA
I her
the
Owner or agent:
nday, September 8, 2008
2�eptember 14, 2007
J that the construction on the above c
the tam, rules and regulations of the
of i=_deral Way.
Date: r 1 41 —0—/
FINALED
0
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 07 -105149 -00 -EL
Owner: VIRGINIA MASON MEDICAL CENTER
Address: 33501 1 ST WAY S
FEDERAL WAY, WA 98003-6208
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.
❑ Slab/Concrete Floor (4255) ❑ Ditch cover (4030) ❑ Pool Bonding (4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power (4275) ❑ Service (4235) ❑ Feeders/Sub-panels (4045)
Approved Approved Approved
By Date By Date By Date
❑
Rough Electrical (4225)
Approved
By
/
Date 6 - L Tal
❑
UFER Ground (4295)
Approved
By
Date
❑ Ceiling Cover (4020)
Approved
By Date
❑ Final -Electrical (4055)
Approved
Date /Q'
For inspector ctor reference only
—_ _
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
CRY OF -Aa
Federal W,by R��E� PERMIT
C0"UNrYD8V=.JEMrsaRVICU SF MF CO ME '�L DE EN FP
999258ft AVV0 SOU1H. POBOX 97,8FEDMU 0
159595.2607 WAY, WA
5-960 S91 � .�..�I CAT I O N
FFQ pEP� • '
The following is requfiloF n - an incomplete application will not be accepted. Please print•legibiy (in ink) or type.
PROPERTY INFOIUIATION
SITE ADDRESS SUITE/UNIT #
CC��
ASSESSOR'S TAR/PARCEL f . I S C, i -i - O L2 1-C—)LOT SIZE (S17
.LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(el +yw!oe.PWf-hmft&wddowW wQ
PROJECT• •
TYPE OF PERMIT O BUILDING O PLUMBING - O MECHANICAL
O DEMOLITION RIBI.ECTRICAL O ENGINEERING ❑.FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul
PROJECT. NAME (Name of sines or Owner Last Namel
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
PEOPLE INFORIIIATION
NAME I
PRIMARY PHONE
OFFICE PHONE
A,AILINO ADDPAPS
.0. 7�C
CITY 8TATE.7P
S {�.l��l 6-)%
PHONE
- J .
MAILING A(DD S[� Y�
CITY, STATE, ZIP
E-MAIL ADDRESS
I ` (� Qe
COMPANY NAME
'K 4� �Q t«
A, CANT NAME
OFFICE PHONE
A,AILINO ADDPAPS
.0. 7�C
CITY 8TATE.7P
S {�.l��l 6-)%
PHONE
- J .
OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
CONTRACTORV REOIBTRATION l7II TION DATE
II' `
E-MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELLPHONE
RELATIONSHIP TO PROJECT
E3 Architect o Tenant 17 Agent o Other
FAX NUMBER
NAME PRIMARY PHONE EMAIL ADDRESS
NAME
Per RCW 19.97.095:
Lender infoi nation is required j/project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER
SEWER SERVICE PROVIDER
o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES O NO
o LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
o LAKEHAVEN o HIGHLINE 0 PRIVATE (SEPTIC)
PROJECT ••-
AREA DESCRIPTION
BASEMENT
AREAS
-EXISTING
SQ : FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
FIRST
o YES. o NO
BASIC PLAN? *
o YES
SECOND
ZONING DESIGNATION
CHANGE OF USE?
THIRD
o NO
NEW ADDRE$8 REQUIRED?
o YES o NO
ADDITIONAL FLOORS (DESCRIBE)
o YES
o NO
PLATTED LOT?
DECK (O COVERED OR O UNCOVERED?)
DEMO PERMIT REQUIRED?
o YES
o NO.
GARAGE0 CARPORT O
NUMBER OF FLOORS
ssurno
rroro•ss
corm.
ronasaenssu
rar�crroraterrr
rorv:u
"NEWHOMESONLY" . NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fteure to be installed or relocated as part of this project. Do not include existing furfures to remain.
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (crab/9--,cemb4
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
I.AVS p a�oem sb*q
RAINWATER SYST
SHOWERS
SINKS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (C—erdoq
RANGES
REFRIG. SYSTEMS
URINALS .
VACUUM BREAKERS
WATER CLOSETS jroseq
WASHING MACHINES
WOODSTOVES
T MISC (Describe)
MISC (Describe)
I cavy under penalty of perjury that ! an the property owner or authorised agent of the property owner. I eert(jy that to the best of my
knowledge, the igformation submitted in support of this permit application is true and correct. 1 ce tO that I will comply with all applicable
City of Federal ,Wa{y regulations pertaining to the work authorised by the issuance of a permit. ! 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 f urther agree to hold harmless the City of Federal Was to any claim /including costs, expenses, and attorneys' fees incurred in the
investigation and dgfense of such claim), which may be a by officers
person, including the undersigned, and flied against the city, but only
where such claim arises out of the rs a� of the city ding its and employees, upon•the accuracy of the information supplied to
the city as apart of this•a;pplica4elL . \
SIGNATURE:
o NEW a ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES. o NO
BASIC PLAN? *
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRE$8 REQUIRED?
o YES o NO
IIP/SEPA/SU?
o YES
o NO
PLATTED LOT?
DYES o NO
DEMO PERMIT REQUIRED?
o YES
o NO.
Bulletin # 100 _ August 16, 2007 Page 2 of 4 . k\Handouts\Permit Application