05-103394 S
City of
unity Development Services Federal Way
Community DElectrical Permit #: 05 - 103394 - 00 - EL
�� ---
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: ST FRANCIS MEDICAL PAVILION
Project Address: 34509 9TH,5�Pry Parcel Number: 750451 0010
Project Description: Connecting(3)signs to existing j-box
Owner Applicant Contractor
FRANCISCAN HEALTH SYSTEM- PLUMB SIGNS INC*CONNIE GUFFEY* PLUMB SIGNS INC*CONNIE GUFFEY*
1717 SJ ST 909 S 28TH ST 909 S 28TH ST
TACOMA WA TACOMA WA 98409 TACOMA WA 98409
98405-4933 (253)473-3323
Electrical Fixtures
Description Quantity Description Quantity Description Quantity;
sign 3 -- -- -- —
PERMIT EXPIRES January 9,2006.
Permit issued on July 13,2005
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 agent: /;:: Date: I3 •
THIS CARD IS TO REMAIN ON-SITE
CITY OFA. Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-103394-00-EL
Owner:
Address: 34509 9TH AVE S
FEDERAL WAY, WA 98003-6700
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.
ElSlab/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) 121 Final-Electrical(4055)
Approved Approved Approved
By Date By Date By ` 1\, ' Date a. .1 6
❑ Under-slab groundwork(4295)
Approved
By Date
< i RECEIVED
05.- 423.31Y
Federal way Jug 1 3 2005 PERMIT api,COMMUNITY DRYELOPMENTSERVICESSF MF COM DE EN FP
33725 Pa AVENUE FEDERAL WAY,WA 9 - w r- F EDERA 'PLICATION
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ss3asss6o7•FAX253d3ILDING DEP / /
www.cityoffederahuay.com
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The ollowi • is •uired in ormation-an Inco .tete • • •lication will not be acce•ted. Please •rint to•ibl in or p -.
'' ■ PROPERTY INFORMATION
SITE ADDRESS 5((-1 S�') — Qat_ Aye S 1 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 7 ST O / 6- 1
L - Q () I U LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) . FK. Z v1C S N Cdr C q,(
(Aged,agwwtePcgoJwknWwkwtdescrOdon)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
I0 DEMOLITION'XELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
1 PROJECT DESCRIPTION(Provide detailed des ' tion of work included on this permit on
S4CkjI Lem-te,_ t' '
oak)Qv� ..Ste_ . ? I . _ et' -I
- ,l 1 Le—ei2 " `l04 So
1/0e.14 eqP_✓,
PROJECT NAME(Name of Business or Owner Last Name) Sof' FkQi,/Cid rfi J
II PEOPLE INFORMATION
PROPERTY NAME,...)
NAME�
PRIMARY 1iONE
OWNER t��R�YCl S �t�jc. .,/ I -
MAILING ADDRESS CITY,STATE.
e �+C ZIP GL/ A l A _
CONTRACTOR COMPANY NAME APPLICANT NAME "" WOFFICE PHONE
Plu-(.t.,L Sissks ,The , C . ve G L&.. (2-Y3 9'73 -3 3
MAILING
''rADD ^l CITY,STATE,ZIP CELL PHONE
10
AI
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER XPIRATIOI DATE FAX NUMBER
- L c 3) )7L - 31c 7
TTACTOR'S REGISTRATION NUMBER(copy of carrr with each application( EXPIRATION DATE
APPLICANT NY NAME
APP CANT NAME OFFICE PHONE//f
N � CIARpRESS /.. ,,ST e (*-2-76 `7 7�- `33 4
CF
CELL PHONE
9'4 l ♦ . Z e . .Tb'C . bu , ( (
RELATIONSHIP TO PROJECT FAX NUMBER
a Architect ❑Tenant ❑Agent a Other(Describe) (?&' / 7 -3 107
CONTACT NA PRIMARY PHONE
E-MAIL ADDRESS
yu e e c (-na)- 33J.3 •
LENDER
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
f EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
I SPRINKLERED BUILDING? a YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN a HIGHUNE a TACOMA ❑PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE a PRIVATE(SEPTIC)
•
s•'
4 + PROJECT FLOOR AREAS
Itt i
• " D RIPTION EXISTING PROPOSED TOTAL
_ SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH •
•
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT 0
EXIST= PROPOSED TOTAL ;. a,_(x1 � ,r: (fir a IF
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 Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
• COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS _ GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower cembo) SHOWERS WATER CLOSETS(Loses MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
[AVS(Bathroom ado) 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/TITLE ,� ///, DATE 13/C) Sr----
(Signature) (Title)
RELATIONSHIP TO PROJECT o Owner a Agent Contractor 0 Architect ❑ Other
wc}
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application
ELECTI .FORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
❑ Single Family Square Feet Service or Feeder Each Add'n
(First 1300 fta-$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 398.5G . 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 ❑ Mast or meter repair $96.00
❑ 401 -600 amp 193.00 96.00
❑ 601 -800 amp 247.00 132.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ Over 800 amp 353.50 264.50 Service or Feeders
❑ 0 to 200 amp $113.50
ALTERED SINGLE/MULTI FAMILY 0 201-600 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
1 MOBILE HOME/RV PARK Residential/Multi-Family $61.00
❑ #of service or feeders
(First service/feeder-$69.50;each add'n-$45.00) Conunercial/lndustrial Service or Feeder Ampacity
U 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
❑ #of Thermostats 0 3 Hof 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) (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)
❑ Data Cabling ❑ Automation Fee on all Permits $5.00
CI
(Per System(s) la 2500 ft2$61.00;
Each add'n 2500 ft2-16.00)•Per WAC 296-46-910(46/(1&Ii)
Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application