02-105304 City of Federal Way
Community Development Services Electrical Permit #:02 - 105304 - 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 OUTPATIENT IMAGING
Project Address: 34515 9TH S Parcel Number: 750451 0020
Project Description: ELE-Electrical for addition to fire alarm system
Owner Applicant Contractor
ST FRANCIS MEDICAL SIMPLEXGRINNELL LP SIMPLEXGRINNELL LP
1717 S J ST 9520 10TH AVE S SUITE 100 9520 10TH AVE S SUITE 100
TACOMA WA SEATTLE WA 98108 SEATTLE WA 98108
98405-4933 (206)291-1400
Electrical Fixtures
16s� '�'t:I'Description': r ;'. =.21'" r1 M ieQuantity Descriptio f "i:'
Low Voltage Fire Alarm-Commercia 2500
PERMIT EXPIRES May 24,2003,IF NO WORK IS STARTED.
Permit issued on November 25,2002
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: 4y�4‘l Date: I f/2Sloz
l2.. lCc-07- E-NAL. 1 pr
&I/
(.
1.1
Y
G CONSTRUCT 11ON PERMIT APPLICATION
\>\> �ErzRL RECEIVED APPLICATION NUMBER: CZ. - LO,c,3C;�� -
NOV 2 5 1002 APPLICATION NUMBER: -APPLICATION NUMBER: -**The fQiciWi TfE>I�isiicLilifO(t(hation—Please print(in ink)or type**
BUILDING DEPT.
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
• PROPERTY INFORMATION
SITE ADDRESS: 3W SIS .// q•(/{ ,S, ASSESSOR'S TAX/PARCEL#:
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION' : -.
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
( 4LECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): L /P ( i("41 ( i/// ✓ I' rJt /1lN,4
PR+JECT NAME: �-f,. pan cic
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYIIME PHONE:
s� FrAkicJ ( )MAIUNG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: //J `/'/��'/ „;14 (`(J (DAAYTIMME PHONE
MAIIING3 i M (/ REET ADDRESS;CI�`TY`STATE ZIP): EVENING) 24/pN - /qx
/S'2v l 1 eL t. S- 5 ,- 7th
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
(20' )247/ - /COO
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
(copy d card required) -C12 e L L *it L S4 D / l07 /oY
APPLICANT: NAME: DAYTIME PHONE:
MAILING
,'(STREET ADDRESS; STPD ZIP): E�6EVENING�?,/
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑TENANT ❑ OTHER(DESCRIBE): ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT ❑ CONTRACTOR
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PRO3ECT FLOOR AREAS - -
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL: y.�
.... .'.-.•...n�.e+....< �.>.>"�.�:._:w_ .. .xWc2;rxvsr.•. tsk-us'r+Sv s+Y•+iR•FIA•ORES•Xr:::+ .n.rrv;47.4—. •s%a::%awi .rr.•ai.::a•wyYvv.s�re S.c+
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑-CAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
- - -■ '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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,including the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information upplied to the city as a .•rt of this application.
NAME/TITLE: 1/./A_
DATE:
❑ PROPERTY OW R ❑ APPLICANT ❑ CONTRACTOR
4FOR;OFFICE USE ONLY:
pp(����I��N_(-ElN ❑ADDITION .:s;i •ALTERATION ; AZO.REPAIR=y, -, OITE lANTiIMPROVEM ENT" :;_
ICE�SUSt _ - -
,CODE;
.. x.• r i i�.-.Y•_• •_ _ ..a.y:_,y x
#4-9'_ efill-GNA O '7 ,-'r BUILDINGSHELlONL1(? �1fES C :(VO �S s'-'
T0 "P'P D'ESIGIVATION 1;' SXC�l ? .. �S_V fN0
Y.p ,y �� .n��.T4KIf"F+.� `lf.�.'+5-�+i4GJY•.e.cr�F 4..'.'•lSi�.i.t� §..i't'S.l ' 3d�--
gECTiONT i_-TQcVNSFIIP� ,- RANGE fir;_,,• ;NEW IDDRESS itEQUIRED?fit. . YES��� f 0 -
�.LQ� � fww.v�xve= -__ ,•y.v_ 4zYc'_ ".'E>i�Ci�_-'3`_:_ _ •_� 1e.�3�2�a'Fxi'i.'Z�t
T?:3=❑-(ES
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063.9718.253-661-4000•FAX:253-661-4129
www.dtvoffederalwav_oom
Construction Permit Fee Calculation Sheet
*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CITY STAFF PRIOR TO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WILL NOT BE ACCEPTED!*******
Building,mechanical,and fire prevention system fees are based on the following schedule.
TABLE A
TOTAL VALUATION FEE FACTOR
(1)$1.00 to$500.00 (1)$26.00
(2)$501.00 to$2,000.00 (2)$26.00 for the first$500.00 plus 13.50 for each additional S100.00 or fraction thereof,to and induding
$2,000.00
(3)$2,001.00 to$25,000.00
(3)$78.50 for the first$2,000.00 plus 115.50 for each additional 51.000.00 or fraction thereof,to and
induding$25,000.00
(4)$25,001.00 to$50,000.00
(4)$435.00 for the first$25,000.00 plus$11.00 for each additional$1.000.00 or fraction thereof,to and
including$50,000.00.
(5)$50,001.00 to$100,000.00
(5)$710.00 for the first$50,000.00 plus 58.00 for each additional$1,000.00 or fraction thereof,to and
including$100,000.00.
(6)$100,001.00 to$500,000.00
(6)$1,110.00 for the first$100,000.00 plus$6.00 for each additional3'1.000.00or fraction thereof,to and
induding$500,000.00
(7)$500,001.00 to$1,000,000.00
(7)$3,510.00 for the fist$500,000.00 plus$5.50 for each additional$1,000.00 or fraction thereof,to and
including$1,000,000.00.
(8)$1,000,001.00 and up
(8)$6,260.00 for the first$1,000,000.00 plus$1.00 for each additional$1,000.00 or fraction thereof.
Bold number Is the base fee for the specified Increment
Jtalidzed,underlined number Is the fee per additional specified Increment
PLUS: Add 65 percent of the base building permit fee for plan review fee.
Add 25 percent of the base mechanical permit fee for mechanical plan review fee.
Add 15 percent of the base building permit fee for Fire District#39 surcharge,commercial only.
Add$4.50 for WA State Building Code Council,plus$2.00 per unit for duplex&above.
**Electrical,plumbing,and mechanical fees are calculated separately**
■ BUILDING . _.-
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee: •
(b)Additional Increment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
■ MECHANICAL •
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
• FIRE PREVENTION SYSTEM
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A:Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
• . .. • • : • • .■ PLUMBING . . . .. . • . . .
Base Fee Number of Forburs
$22.50+{ X$8.00/fixture)= (8)Estimated Permit Fee
Estimated Permit Fee
X .65= (9)Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
Sub Total(Paye one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10)= (11)
• • •-ELECTRICAL
TABLE B
•
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $50.00 _#of Thermostats(First-$37.50;add'n-$11.50ea)
(First 1300 ft2-$75.00;Each add'n 500 ft2-524.00) _Service and feeder $81.00 Xs_#of Low voltage fire or burglar alarms
Square Feet: First 2500 ft2443.50 Each add'n 2500 ft2-$11.50
_Each outbuilding or garage $3 L00 MOBILE HOME/RV PARK Square Feet: inbr2
(Inspected with service) _#of service or feeders *Per WAC 296-46-910(5)(b)(i&ii)
_Each outbuilding or garage $50.00 (First service/feeder-$50.00;Add'n service/ _#of Signs(First sign-537.50;add'n sign
(Inspected separately) feeder-$32 each) $17.50 each)
_Swimming pool,hot tub,spa $75.00
_Yard Pole meter loops $50.00
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL
(Includes three units or more) Altered Service or Feeders
Service Feeder Amps Service or Add'n _0 to 200 S 81.00
Up to 200 amp $ 81.00 $ 24.00 Feeder _201-600 189.00
_201-400 amp 101.00 50.00 _0 to 100 S 81.00 $ 50.00 _601-1000 284.50
_401-600 amp 138.00 68.50 _101-200 101.00 63.50 _over 1000 317.00
_601-800 amp 176.50 94.50 _201-400 189.00 75.00 _#of circuits
_Over 800 amp 252.50 189.00 _401-600 220.50 88.50 (1-5 circuits-563.50;Add'n circuits,$5 ca)
ALTERED SINGLE/MULTI FAMILY _601-800 284.50 120.50
(When inspected separately from the services.) _801-1000 348.00 145.50 TEMPORARY SERVICE
Service or Feeder _Over 1000 379.00 202.50 Residential/Multi-Family/Commercial/Industrial
_0 to 200 amp $ 68.50 _Over 600 volts surcharge 63.50 _0-100 S 50.00
_201-600 amp 101.00 _Mast or meter repair 68.50 _101-200 63.50
_over 600 amp 151.50 _201-400 75.00
_Mast or meter repair 37.50 _401-600 101.00
#of circuits _over 600 109.00
(1-4 circuits-$50.00;Add'n circuits S5 ea)
1f a new or altered commercial service is 200 amps or greater,or a new or altered residential service is greater than 400 amps,a plan review is required.Fee is 35%of
permit fee+563.50.Add'l plan review for other submissions is$75.00/hr.
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B"(B) NUMBER OF UNITS(C) -TOTAL(D)
•
TOTAL COLUMN(D):
Total Column(D)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $63.50+( X.35)=(13)
■ DEMOLITION
Estimated Permit Fee: (14)
Bond Amount:(15)
IN ENGINEERING
Estimated Permit Fee:(16)
Bond Amount: (17)
k - ■ OTHER FEES
Mitigation Fee:(18) (20) (22)
s SBCC Surcharge:(19) - (21) (23)
Total (Pages one&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23)= (24)
Bulletin#100-February 19,2002 f