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05-103107 • • City 8f Federal Way Electrical Permit #: 05 - 103107 - 00 - EL Community Development Services P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-7000 Fax (253)835-2609 Inspection request line: (253) 835-305C Project Name: FEDERAL WAY AMBULATORY SURGERY CENTER Project Address: 34612 6TH.S Vt. Parcel Number: 926480 0010 Project Description: Install low-voltage voice/paging,data,and TV wiring for entire building. Owner Applicant Contractor FWASC,LLC PACIFIC BUSINESS SYSTEM PACIFIC BUSINESS SYSTEM FWASC,LLC PO BOX 1453 PO BOX 1453 PO BOX 890 SUMNER WA 98390 SUMNER WA 98390 BLACK DIAMOND WA 98010 (253)862-7600 Electrical Fixtures Description Quantity Description Quantity Description Lq_uantity! Low Voltage-Other Commercial 18000 PERMIT EXPIRES December 26,2005. Permit issued on June 29,2005 I hereby Certify that theabove 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 Wa Owner or agent: '�' Date: ? � `©S f"\\O r-1 — • \ )\ • / • THIS CARD IS TO REMAIN ON-SITE . - CITY OF Community Development Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT#: 05-103107-00-EL Owner: FWASC, LLC Address: 34612 6TH AVE S FEDERAL WAY, WA 98003 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 ate logged on the back of this card. 0 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 ❑ Rough Electrical(4225) 0 Ceiling Cover(4020) 7.4 Final-Electrical(4055) Approved Approved Approved r By Date By Date B ��1. Date 0 � a.4 ❑ Under-slab groundwork(4295) Approved By Date i , 4► � � n • 0 ,p C O f n 1 RECEIVED 6c ...A ' JUN 2926)_,51 Feaeral Way O PERMIT q ?1 0? COMMUNITY DEVELOPMEN'SERVICES CITY OF FED E Fid \/ CO M •L DE EN FP 33325 DERALW Y,,WA 9 -PO 918 APPLICATI O NUILDING CWT. 1.)253-835-2607.FAX J •y.ai 2609 1 V wuutcRyolredeml ,yoom I The ollowi • is , Ired in ormation-an Inco •lete a••Iication will not be acce•ted. Please 'tint le•ibi n or a PROPERTY INFORMATION SITE ADDRESS 3%e (Z N! / A %/ - • SUITE/UNIT# ASSESSOR'S TAX/PARCEL# y /7 C� y g_ O - D 4 LOT SIZE(sn LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) !Attach$ a page for knew MPJ desoiP6011 ■ PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION pLECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION • aide detailed descrip n of work inclu'ed on t ' .._, it onl 4. i ,e'—`c_ - p4 if /‘ /..__,-0,...,..,-,::/7,- PROJECT NAME(Name of Business or Owner Last Name) S i/'�5 )`C.2 1 ,f,f ejr , al PEOPLE INFORMATION PROPERTY NAME OWNER I-/ / / s c LLC ( )PRIMARY PHONE _ ri MAILINNAADDRESa_ Q G� L . C k,l i CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE \)Gfct i 13 vs;`-1.-s.r Sys-1,,.) �c.c/ c'� (233 - 76'0 MAILING DR CITY,STATE,ZIP CEU,PHONE I'' 80,y _. .:l. -_ )444.Kc Z c%� 3 qt. test ) ?4'/ -; 0700 ' CITY OF FEDERAL AY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER -B / kSJ )FEZ - -,Oo NTRACTOR3 REGISTRATION NUMBER(copy of card required with each applicatiea) EXPIRATION DATE a- .�r22 / TT- / / APPLICANT COMPANY NAME i C r APPLICANT NAME OFFICE PHONE MAILING ADDRESS CITY,STATE,ZIP CELL PHONE RELATIONSHIP TO PROJECT FAX NUMBER ❑Architect ❑Tenant a Agent ❑ Other(Describe) ( ) _ CONTACT NAM -p PRIMARY PHONE E-MAIL ADDRESS • YrIe_ Ee-0's-0(0A (as3) .26t 09Ott LENDER a t, ? r •,-atc•, i, ,r�•4,i. ..'7,010'I MAILING ADDRESS CITY,STATE,ZIP • DETAILED BUILDING!Nr'ORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? ❑ ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO WATER SERVICE PROVID O LAKEHAVEN 0 HIGHLINE O TACOMA a PRIVATE(WELL) SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC) PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST C900SECOND THIRD 8U(70 ?DO c2 FOURTH • ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 EXISTING PROPOSED TOTAL .ate xne ,,,Y.R �. ► .. NUMBER OF FLOORS **NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. MECHANICAL Value of Mechanical • $ • AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOOD'(comourc14 WOODSTOVES BOILERS .. • REPLACE INSERTS :ES MISC(Describe) • COMPRESSORS EU" (-AS WATER HEATERS DUCTS GAS PIPE O PLUMBING BATHTUBS(or Tub/Shower Combo, SHOWERS WATER CLOSETS groaeq MISC(Describe) DISHWASHERS SINKS DRI` • FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER S' ' WASHING MACHINES URIN - HOSE BIBBS LAYS(Bathroom Sinks) V • UM 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 authorised 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 oft ty,including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE - DATE -2 (Signature (Title) RELATIONSHIP TO PROJECT ❑ Owner a Agent a Contractor ❑ Architect ❑ Other +&a1^t `,.,001 E)(0 . e 3•Cis ' ' r _ . `x }�L� F�Ce1it � ���bla� t�.+E bit t 1,�,1Ye� � i��Vt` Bej1. ci .I. Sit%�• € .�It'.' > 7-D1:1 (c ry 4�(e +t,�/ ;( t.-� 0101,!€; aj�.7(Q!y(. I(€)11 i elr�xb�t6)✓!exx IF.�Si „1,;1::;;03 �16r .__. Tl6j 1) (6 iLL Cwt �(,ol r, (6�� •Nr ��r�c�i� +� Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application ELECTI ?GAL PERMIT INFORMATION RESIDENTIAL COMMERCIAL NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE t ❑ Single Family Square Feet Service or Feeder Each Add'n (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 ❑ 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 ❑ 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 ❑ 0 to 200 amp $87.00 ❑ 201-600 amp 141.00 ❑ #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 I MOBILE HOME/RV PARK Resident-Lai/Multi-Family $61.00 ❑ #of service or feeders (First service/feeder-$69.50;each add'n-$45.00) Commercial/Industrial Service or Feeder Ar pacity ❑ 0-100 amps _ $69.50 ❑ I01-200 amps 89.00 ❑ 201-400 amps 104.50 ❑ 401-600 amps 141.00 ❑ over 600 amps 152.50 • MISCELLANEOUS SERVICE/EQUIPMENT I ❑ #of Thermostats ❑ #of Signs Lost-$52.00;add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea) w Voltage ` ❑ Swimming pool/hot tub $87.00 oars Feet to be served by system(s) y0 (Includes additional circuit,if required) ❑ Fire Alarm System ❑ Yard Pole meter loops $104.50 ❑ Security Alarm System ❑ Additional Plan Review $104.50/hour Voice Cabling (for modified submittals) Da(y,Oabling ❑ Automation Fee on all Permits .. $5.00 (Per Sty�steem(s) 1•t 2500 ft2-$61.00; Each add'n 2500 ft2-16.00)•Per WAC 29646-910(5J(6J(&ill it Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application