04-100913 w '
City of Federal Way
Community Development Services Electrical Permit #:04 - 100913 - 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 WOMEN'S HEALTH CENTER
Project Address: 34515 9TH c.. e-5 Parcel Number: 750451 0020
Project Description: Install low voltage data/voice cabling for expansion project.
Owner Applicant Contractor
Hospital Bsp StFrancis INTRACOMMUNICATION NTWK SYS INC* INTRACOMMUNICATION NTWK SYS INC*
2002 ADV DEP PD 5282869 4922 N PEARL ST 4922 N PEARL ST
TACOMA WA 98407 TACOMA WA 98407
(253)761-0418
Electrical Fixtures
` `ltoescriph g4,. :m Quaint 1444:=: Desch tio—:. :;Quantity
Low Voltage-Other Commercial 3606
PERMIT EXPIRES September 12,2004.
Permit issued on March 16,2004
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws,rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: Date: 3 _ o
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COMMUNITY DEVELOPMENT SERVICES
c of 1"1 C E I V' 33530 FIRST WAY SOWN•PO BOX 9718
FEDERAL WAY,WA 98063-9718
Federal Way P MIT APPLICATION 253-6614115•FAX:253-661-1129
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For Office Use Only: N 7"l7F'Fer: _ I_ 6 Q _ _ ? /
BUILDING cDt HY
The ollowin• is re.uired in orm it-art incom.fete . ..lication will not be acce.ted. Please .rint le.ibi (in ink)or -.
►\ PROPERTY INFORMATION
SITE ADDRESS: 3 '/ -1 \ 417--- SQ SUITE/APT#
ASSESSOR'S TAX/PARCEL#: 7.5-e iz, -i- 44.A.L)SQUARE FOOTAGE OF LOT: 3406 �j'
LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1) _ `
(Attach separate page for lengthy legal description)
30 PROJECT INFORMATION
TYPE OF PERMIT(This application): ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed scription of work included on this permit only):
PROJECT NAME(Name of Business/Owner Last Na e): s' d7 ` f - AllrLit _ i
V PEOPLE INFORMATION
PROPERTY NAME: a PRIMARY PHONE:
OWNER ..A 7':✓.1E/141 j�,r�J ,1► P
MAILING ADDRESS(STREET ADDRESS;): CI ,STATE,ZIP
CONTRACTOR: NAME L COMPANY
���/] OFFICE PHONE: �//
2 G� (STREET ce 4 -1 Q/ .CITY, ATE,ZIP CE5ON��/ ow 8
-II7o1X N �-��� iQ 07 (
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: C XPIRATIONDATE: . FAX NUMBER:
-- -- - U( " / OO �/ 3 / (
:.: 1.1.--e_ i 6'11 VO Li
CONTRACTORS REGISTRATION NUMBER: o- EXPIRATION DATE:
(copy of card required with each application) / /
LENDER NAME: DAYTIME PHONE:
pt Proposed Value>$5,000) (
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP
APPLICANT: NAME: CO • ' OFFICE PHONE:
(
MAILING ADDRESS(STREET ADDRESS): CITY,STATE,ZIP EVENING PHONE:
(
RELATIONSHIP TO PROJECT: FAX NUMBER:
0 Architect 0 Tenan 0 Other(Describe' ( ) -
CONTACT PERSON FOR THIS PRO ECT: 0 Property Owner Contractor 0 Applicant E-MAIL ADDRESS:
• DETAILED BUILDING INFORMATION
EXISTING USE: _ • • • -• ED USE: _ •
XISTING ASS .SED/APP• • •ED VALUE $ VALUE OF ' •OPOSED WORK: $ -
S' • NKLERE BUILDING? 0 • 0 NO FI• UPPRESSION SYSTEM PR• ••SED/REQUIRED : 0 YES 0 •
WA R SE• CE PROVIDER ❑ L• •. •VEN • IGHLINE ❑ TACOMA 0 • • ATE(WEL
SEWE- : RVICE PROVIDER 0 LAKE _ • ❑ HIGHLINE ❑ PRIVATE(SEPTIC) -$
■ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIR'S
SECOND
THIRD
FOURTH
-ADDITIONAL FLOORS(DE RIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
**NEW HOMES ONLY" NUMBER OF BEDROOMS: E`r' •TED SELLING PRICE: $
• i aTURES
Indicate number of each type of fixture that is to be installed or eloca -. as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
--AIR HANDLING UNITS VAPORATIVE COOLERS G - LOGS REFRIG.SYSTEMS
BBQS FANS HOO b IComm q WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER •TERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BA BS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(Toile) ISC(Describe)
SHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sink VACUUM BREAKERS ELECTRIC WATER HEATERS
'�•1 DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that - 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 e •loyees upo% the accuracy o e information supplied to t city as a part of this application.
NAME/TITLE: i ATE: J a ` o5
(Signature) (Title)
RELATIONSHIP TO PROJECT: 0 Property Owner 0 Applicant kontractor 0 Architect ❑
•
,FOR OFFICE USE ONLY: •
❑NEW a ADDITION a ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? o YES o NO
• ..ZONING DESIGNATION: CHANGE OF USE? o YES o NO
•
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES ❑NO
I;u!len t:(-I;: ;,i - • , Page 2
■ ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
❑ Single Family Square Feet: Service or Feeder Each Add'n
(First 1300 ft2-$87.00;Each add'n 500 ft2-$28.00) ❑ 0 to 100 amp $ 94.50 $ 58.00
❑ Detached outbuilding or garage ❑ 101-200 amp 117.50 74.00
(Inspected with service) $36.50 ❑ 201-400 amp 220.50 87.00
❑ Detached outbuilding or garage ❑ 401 -600 amp 256.50 103.00
(Inspected separately) $58.00 ❑ 601-800 amp 332.00 140.50
NEW MULTI-FAMILY(three units or more) ❑ 801 1000 amp 405.50 169.50
Service Feeder ❑ Over 1000 amp 442.00 236.00
❑ Up to 200 amp $ 94.50 $ 28.00
❑ 201 -400 amp 117.50 58.00 ❑ Over 600 volts surcharge $74.00
❑ 401 -600 amp 161.00 80.00 ❑ Mast or meter repair $80.00
❑ 601 -800 amp 206.00 110.00 ALTERED.COMMERCIAL/INDUSTRIAL
❑ Over 800 amp 294.50 220.50
Service or Feeders
ALTERED SINGLE/MULTI.FAMILY ❑ 0 to 200 amp $ 94.50
(Inspected separately from service) ❑ 201 -600 amp 220.50
Service or Feeder ❑ 601 - 1000 amp 332.00
❑ 0 to 200 amp $ 72.50 ❑ over 1000 amp 369.50
❑ 201 -600 amp 117.50
❑ over 600 amp 177.00 ❑ #of circuits to be added/altered
(1-5 circuits-$74.00;Add'n circuits,$6.00/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$58.00;Add'n circuits$6.00/ea)
❑ Service over 200 amps
U Mast or meter repair $43.50 ❑ Medical/Educational/Institutional Facility
$74.00 plus 35%of Permit Fee
SINGLE/MULTI FAMILY PLAN REVIEW
U Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES TEMPORARY SERVICE
❑ Service or feeder only $58.00
❑ Service and feeder $94.50 Commercial Residential
❑ 0- 100 $58.00 $51.00
MOBILE HOME/RV PARK ❑ 101 -200 '74.00 51.00
❑ #of service or feeders ❑ 201 -400 87.00 n/a
(First service/feeder-$58.00;each add'n-$37.50)
❑ 401 -600 117.50 n/a
❑ over 600 127.00 n/a
•
MISCELLANEOUS SERVICE/EQUIPMENT
>uC
❑ #of Thermostats ❑ #of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ea)
U Low Voltage )) �/ ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s):.9.1,04 (Includes additional circuit,if required)
❑ Fire Alarm System ❑ Yard Pole meter loops $58.00
❑ Security Alarm System ❑ Additional Plan Review $87.00/hour
voice Cabling (for modified submittals)
Data Cabling
(Per System(s): 1•,2500 ft2-$51.00;
Each add'n 2500 ft2-13.50)•Per WAG 29616910(5)(b)'i&u)
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