19-10043141kt
CITY OF
Federal Way
RECE1 V`E;D
JAN 2 5 2019
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenteraucityoffederalway com
PERMIT NUMBER / Y — / —QS -3 j _ —Cp
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
35002 Pacific HwV South Federal Wav Wa. 98008
A-105
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ 2,500.00
1 8 5 2 9 5- 0 0 5 0
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
Seattle Pain Relief Ambulatory Surgery Center
Fire Alarm TI. Adding 31 fire alarm devices.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
FEDERAL WAY CROSSINGS OWNER LLC
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
NAME
PHONE
Seacom Calblin
425-317-8259
MAILING ADDRESS
E-MAIL
CONTRACTOR
3014 Hoyt Ave
Kolsen@callseacom.
CITY
STATE
ZIP
FAX
Everett
�Wa
98201
425-317-8261
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
SEACOCI944DO
12/31 /201,120
-16 -105687 -00 -BL
NAME
PRIMARY PHONE
Seacom Cabling
425-314-8259
MAILING ADDRESS
3014 Ho t Ave
E-MAIL
Kolsen@callseacom.
APPLICANT
CITY
STATE I
ZIP
FAX
Everett
Wa 198201
425-317-8261
NAME
PRIMARY PHONE
PROJECT CONTACT
Ken Olsen
425-317-8259
MAILING ADDRESS
3014 Hoyt Ave
E-MAIL
Kolsen@callseacom.
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
Everett
lWa
198201
425-317-8261
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized 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.
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,
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.
SIGNATURE: e—, DATE 1/22/2019
PRINT NAME: Ken Olsen
Bulletin #100 — January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application
J
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each (Upe of cxture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (Commercial(
BOILERS FURNACES HOT WATER TANKS (Gas(
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
# of
Stories
Additional Information
NEW BUILDING
EXISTING/ PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
Indicate how manm of each type of
fixture to be installed or relocated as
part of this project. Do not include existigg fixtures to remain.
BATHTUBS (or Tub/Shower Combo)
LAVS (Hand Sinks(
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
TOTAL BUILDING
DRINKING FOUNTAINS
SINKS (kitchen/utility(
WATER HEATERS (Electric(
1
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
# of
Stories
Additional Information
NEW BUILDING
EXISTING/ PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
ADDITION
,<-,Yes No
Yes No
911,089
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
...............................................................................................................................
BASEMENT
FIRST FLOOR (or Mobile Home)
...............................................................................................................................
SECOND FLOOR
..........................................................................................................................
COVERED ENTRY
............................................................................. .........................................
DECK
...............................................................................................................................
GARAGE - CARPORT
..............................................................................................................................
OTHER (describe)
...............................................................................................................................
Area Totals EXISTING PROPOSED TOTAL
"NEW HOMES ONLY**
ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
TOTAL BUILDING
233, 14 6
Group B
1
TENANT AREA ONLY
1490
Group B
1
PROJECT AREA ONLY
1490
G.]. O U B
1
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application