05-102152 ,City of
Development
Federal Way Electrical Permit #: 05 - 102152 - 00 - EL
Community DServices
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: ST FRANCIS HOSPITAL SATELLITE NURSE'S STATION
Project Address: 34515 9TH I iCk1G S Parcel Number: 750451 0020
Project Description: Install low-voltage voice/data cabling.
Owner Applicant Contractor
FRANCISCAN HEALTH SYSTEM INTRACOMMUNICATION NTWK SYS INC INTRACOMMUNICATION NTWK SYS INC
1717SJST 4922NPEARLST 4922NPEARLST
TACOMA WA 98405-4933 TACOMA WA 98407 TACOMA WA 98407
(253)761-0418
Electrical Fixtures
Description Quantity Description ,Quantity Description Quantity
I Low Voltage-Other Commercial 400
PERMIT EXPIRES November 5,2005.
Permit issued on May 9,2005
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 Way.
Owner or age gEW= Date: ,- (r e9,3-
0 0,4C 3—
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THIS CARD IS TO REMAIN ON-SITE
CITY OF A Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-102152-00-EL
Owner:
Address: 34515 9TH AVE S
FEDERAL WAY, WA 98003-6761
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.
O Slab/Concrete Floor(4255) 0 Ditch cover(4030) 0 Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power(4275) 0 Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
O Rough Electrical(4225) 0 Ceiling Cover(4020) 171 Final-Electrical(4055)
Approved Approved Approved
., .
A.
By Date By Date B .1 Date S (IL\oc--
❑ Under-slab groundwork(4295)
Approved
By Date
CITYOfRECEIVED - (_-)5 - 1 • s,a-
Federal Way PERMIT
COMFEMUNmDEVELOPMENT SERVICES �p5 SF MF CO M:0a; DE EN FP
33325 S HDERAL AVEMIEWAY,WA 98SOIIfFI•PO BOX.110971X8971,1-
9718 9l P P L I CATION TU
�1J(AY 0 li /
253.835-2607•FAX 253-835.2609
www.cituoffederalway.com
• CITY OF FEDERAL WAY
The ollowi • is re•ui. I 1 . r ,* -Lan Inco •lete a••lication will not be acce•ted. Please •. 4.ibl in in or • .
• PROPERTY INFORMATION
Niglio
�� a.' e'5 /s . .0/, Alsl2t e 5
• SITE ADDRESS Ni i ° - - - • , Cp 7 5 I� 9 Ave_ CrBuy/4 SUITE/UNIT#k S-, •
i1-e, •Z
ASSESSOR'S TAX/PARCEL# �/ - LOT SIZE(4) WA/
1
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Ailed.separate page for lengthy legal description)
IN PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION pftLECTRICAL Pp ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
odef.yup /. // .Lne.s?'1-.rs.s i lea/iz.2,-S
PROJECT NAME ..ame of Business or Owner Last Name)_7'e/V S_ 7/r1'/L4cpootto leek.tkXi -
t . ' 7: .
• PEOPLE INFORMATION `
PROPERTY NAME
,// PRIMARY PHONE
OWNER �fj0tt � sf901' , , vCe c-41-Ai Ma ' GS•rAt t ( )
MAILING ADDRESS CITY,STATE,ZIP
3Vrir 414'Arc Se ro414kit.e4,17i W11, .:C49613
CONTRACTOR COMPANY NAME APPLICANT NAME
OFFICE PHONE
7-,V S.7- Gicl�t�t,/ c/� V s3 ) 7c/ e'v/S
1 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
rc'I'22.- ,v, 44-or-1 SV 7nr_ w/e". 1'i i49'-7 63 )7,2 93 fir
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
izQ-QL-1 0 04' _- B L �,,._ /3 /d -
CONTRACTORS REGISTRATION NUMBER(copy of required with each applicatioup ( EXPIRATION DATE
? - Ae a /Vs_ 2 2. y / /o /07
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
1 Ztisz ( ) -
MAILING ADDRESS CITY,STATE,ZIP - CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT NAMEPRIMARY PHONE E-MAIL ADDRESS
L00449-17 d .` (rs 3 ) 732--'53i/S—
LENDER
4 3VSSLENDER :T_= :{, , ..f-i 1.•1 ✓'y;t".4, NAME
r„'lift,.,-„Eif .0:1(9r-,:4,*,;,4!S i;3l•”t-,,, Phi.,'•
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE) •
DECK(COVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTAL 'i•, 1=f0 y.'ha.. Ai:�RoroeED:Sr?,,.,- - AL{r'411
NUMBER OF FLOORS •
a's_ . '*
**NEW HOMES ONLY" NUMBER OF BEDROOMS D SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be Inst• -d or relocated as part of this pro'• t. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commerci.q WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESS FURNACES GAS WATER HEATERS
DU GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower combs SHOWERS WATER CLOSETS(roaeq MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS 1
LAVS(Bath,.omsinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
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/TITLDATES 9'03
(S ure) • (Title)
RELATIONSHIP TO PR T 0 Owner ❑ Agent ❑ Contractor 0 Architect ❑ Other
•
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Pcrmit Application
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder Each Add'n
❑ Single Family Square Feet
(First 1300 ft2-$104.50;Each add'n 500 ft2-$33.50) ❑ 0 to 100 amp $113.50 $69.50
❑ Detached outbuilding or garage ❑ 101-200 amp 141.00 89.00
(Inspected with service) $44.00 ❑ 201-400 amp 264.50 104.00
❑ Detached outbuilding or garage ❑ 401-600 amp 308.00 123.50
(Inspected separately) $69.50 ❑ 601-800 amp 398.50 168.50
O 801 - 1000 amp 486.50 203.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 530.50 283.00
Service Feeder
❑ Up to 200 amp $113.50 $33.50 ❑ Over 600 volts surcharge $89.00
❑ 201 -400 amp 141.00 69.50 0 Mast or meter repair $96.00
❑ 401 -600 amp 193.00 96.00 ALTERED COMMERCIAL/INDUSTRIAL
0 601 -800 amp 247.00 132.00
❑ Over 800 amp 353.50 264.50 Service or Feeders
❑ 0 to 200 amp $113.50
ALTERED SINGLE/MULTI FAMILY ❑ 201 -600 amp 264.50
❑ 601 - 1000 amp 398.50
Service or Feeder ❑ over 1000 amp 443.50
❑ Oto 200 amp $87.00
❑ 201 -600 amp 141.00 ❑ N of circuits to be added/altered
' ❑ over 600 amp 212.50 (1-5 circuits-$89.00;Add'n circuits,$7.00/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$69.50;Add'n circuits$7.00/ea) $89.00 plus 35%of Permit Fee
❑ Service- 1,000 amps or greater
❑ Mast or meter repair $52.00 ❑ Medical/Educational/Institutional Facility
MOBILE HOMES
❑ Service or feeder only $69.50
' ❑ Service and feeder $113.50
TEMPORARY SERVICE
1 MOBILE HOME/RV PARK Residential/Multi-Family $61.00
I ❑ N of service or feeders
(First service/feeder-$69.50;each add'n-$45.00) Commercial/Industrial Service or Feeder Ampacity
❑ 0-100 amps _ $69.50
❑ 101-200 amps 89.00
O 201-400 amps 104.50
❑ 401-600 amps 141.00
❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats ❑ N of Signs
(First-$52.00;add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea)
❑ Low Voltage ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s) _21,,2e 02'1 (Includes additional circuit,if required)
O Fire Alarm System ❑ Yard Pole meter loops $104.50
❑ Security Alarm System ❑ Additional Plan Review $104.50/hour
Voice Cabling (for modified submittals)
Data Cabling
❑ Automation Fee on all Permits $5.00
(Per System(s) 14 2500 ft2-$61.00;
Each add'n 2500 ft2-16.00) •Per WAC 296-/6-910(5)(6)(&ii)
i
Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application