04-101209 City of Federal Way
Community Development Services Electrical Permit #:04 - 101209 - 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: FRANCISCAN HEALTH SURGERY
Project Address: 34515 9TH$ p1 G 5 Parcel Number: 750451 0020
Project Description: Terminate and program FACP
Owner Applicant Contractor
Hospital Bsp StFrancis SIMPLEXGRINNELL LP(ELECTRICAL) _ SIMPLEXGRINNELL LP(ELECTRICAL)
2002 ADV DEP PD 5282869 9520 10TH AVE S SUITE 100 9520 10TH AVE S SUITE 100
FEDERAL WAY WA 98108 FEDERAL WAY WA 98108
(253)291-1468
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Low Voltage Fire Alarm-Commercia 1
PERMIT EXPIRES September 29,2004.
Permit issued on April 2,2004
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: ,�,>ti, W4 Date: I/Z/01./
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COMMUA7IY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH•PO BOX 9718
•FEDERAL WAY,WA 98063-9718
Federal Way PERMIT °PLICATION 253661-4115•FAX:253-661-4129
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For Office Vsr Only. 2- {) q_ — z9---0
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FW File Number: 0 � - 4 0 � F/f�- (( (V_�
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The ollowin• is re.wired in ormation-an inco •iete a i n lication will not be acce•ted. Please •rint le•ibl (in ink)or •e.
/j gill /•f I, PROPERTY INFORMATION
�
SITE ADDRESS: 3 /S/ "/ ill ye• S. [y ed N/dt/-iiVsy *093 SUITE/APT#
ASSESSOR'S TAX/PARCEL#: - _ SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1) /er•,yl;Y1 q Ap d- bag/4 iyi f:,4. £, p
•
(Attach separate page for lengthy legal description)
INFORMATION
TYPE OF PERMIT(This application): 0 BUILDING , PLUMBING 0 MECHANICAL 0 DEMOLITION
)4LECTRICAT I ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of wo luded on this permit onlq,
i Pi,k1 %✓) A fe J" i"a/oln)1 /�. /a. C. P
PROJECT NAME(Name of Business/Owner Last Name):
INFORMATION
PROPERTY NAME: �� /L fPRIMARY PHONE: /(�' r
OWNER rc61/1c;S'i [[
Gtel /7AG `74 S�/cj 'lh ( 2S0 ) 5t / - bb 3J
MAILING ADDRESS(STREET ADDRESS,): CITY. :,ZIP
/7 /7 S. 7. Sfire 9- 7--,7c0P.1671 t,44 '3'$T0 S. 1
NAME COM PAN,1 OFFICE20 PHONE:
1/ /goo
MAILING ADDRESS(STREET ADDRESS;): CITY STATE,lx 6;i/of
I CEONE:
S2° lo A Al i. S S:I•>e lou Seo,-//e, L> gt/0e (ZcC ) 7/0 - ,701 7
CITY OF FEDERAL WAY BUSINESS LICENSE NU EXPIRATION DATE: FAX NUMBER:
/ ( ) -
CONTRACTORS REGISTRATION NUMBER:
C � / ( EXPIRATION DATE:
(copy of card required with each application) ) J M g` [— L / q Q� l so- al 07 /OC
LENDER NAME:/V/ DAYTIME -
of Proposed Value>=s,aool
MAILING ADDRESS(STREET ADDRESS;): CITY,STA1 E,ZIP
APPLICANT: N (�f;n 1/vqrifJ COMPAht OFFICE PHONE:
( 24 6') 291 - ifi
MAILING ADDRESS(STREET ADDRESS) CITY,SI ATE,ZIP EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ Architect 0 Tenant 0 Other :cribeJ: ( ) -
CONTACT PERSON FOR THIS PROJECT: 0 Property Own ❑ Contractor /Applicant E-MAIL ADDRESS:
■ DETAIL " 't I DING INFORMATION
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRI RESSION SYSTEM PROPOSED/REQUIRED?: ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HI( :0 ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HA. .0 Li PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
- AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT: TOTAL
•
BASEMENT
FIRST ' • •
SECOND • - .
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
•
- HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
"NEW HOMES ONLY*` NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ .
• FIXTURES
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
- AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
ggQS FANS HOODS(commercial)
WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Show<rCombo) SI ,,.ERS WATER CLOSETS(Toile) MISC(Describe)
DISHWASHERS SINES DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES UPI\ALS HOSE BIBBS
LAVS(Bathroom Sink 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,upoi the accuracy of the information supplied to the city as a part of/this application.
NAME/TITLE: I li" DATE: �/ Z�O"/
/
(Signature `/ (Title) ill
RELATIONSHIP PROJECT: ❑ ' .perry Owner ❑ Applicant o Contractor 0 Architect 0
FOR OFFICE,USE ONLY; -
❑NEW o ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? o YES n NO
ZONING DESIGNATION: CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? ❑YES a NO
.c1,.1 ,10`.; .:,. . . . ' . • Page 2
• ELECTRICAL ?ERM !'FORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDEN'T`IAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE •
LISingle 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 LI 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) LI 801 - 1000 amp 405.50 169.50
Service Feeder LI Over 1000 amp 442.00 236.00
LI Up to 200 amp $ 94.50 $ 28 00
❑ 201 -400 amp 117.50 58 00 LI Over 600 volts surcharge $74.00
❑ 401 -600 amp 161.00 80.00 ❑ Mast or meter repair $80.00
LI 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) LI 201 -600 amp 220.50
Service or Feeder LI 601 - 1000 amp 332.00
LI 0 to 200 amp $ 72.50 LI over 1000 amp 369.50
❑ 201 -600 amp 117.50
❑ over 600 amp 177.00 LI #of circuits to be added/altered
(1-5 circuits-$74.00;Add'n circuits,$6.00/ea)
LI #of circuits to be added/altered
(1-4 circuits-$58.00;Add'n circuits$6 00/c.,) COMMERCIAL/INDUSTRIAL PLAN REVIEW
❑ Service over 200 amps
LI Mast or meter repair $43.50 ❑ Medical/Educational/Institutional Facility
$74.00 plus 35%of Permit Fee
SINGLE/MULTI FAMILY PLAN REVIEW
LI Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES TEMPORARY SERVICE
LI Service or feeder only $58.00
-
LI Service and feeder $94.50 Commercial Residential
LI 0- 100 $58.00 $51.00
MOBILE HOME/RV PARK LI 101 -200 74.00 51.00
LI #of service or feeders LI 201 -400 87.00 n/a
(First service/feeder-$58.00;each add'n-$37 50) .
LI 401 -600 117.50 n/a
LI over 600 127.00 n/a
MISCELLANEOUS SERVICE/EQUIPMENT
LI #of Thermostats ❑ #of Signs
first-$43.50;add'n-$13.50/ea) (First sign $43.50;add'n sign$20.50/ea)
Low Voltage LI Swimming pool/hot tub $87.00
uare Feet to be served by system(s)' (Includes additional circuit,if required)
ire Alarm System LI Yard Pole meter loops $58.00
❑ Security Alarm System LI Additional Plan Review $87.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
0
(Per System(s): 1.42500 ft2-$51.00;
Each add'n 2500 ft2-13.50) *Per WAC 296-46-910(5)(b)(i Qa a)
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