05-103319 •
City of Federal Way Electrical Permit #: 05 - 103319 - 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 Suite100 Parcel Number: 926480 0010
PAM
Project Description: Installing one 225 amp panel and 3-125 amp panels on first floor of new medical center,including wiring.
Owner Applicant Contractor
FWASC,LLC DANARD ELECTRIC INC DANARD ELECTRIC INC
FWASC,LLC 18819 38TH AVE E 18819 38TH AVE E
PO BOX 890 TACOMA WA 98446-1142 TACOMA WA 98446-1142
BLACK DIAMOND WA 98010 (253)875-8650
Electrical Fixtures
Description iQuantity I Description [Quantity Description 14uantityl
IService/Feeder: 101-200 amps-Comr 3 ! Service/Feeder:201-400 amps-Comr 1
PERMIT EXPIRES January 7,2006.
Permit issued on July 11,2005
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use wil be ' accordanc- with . s,rules • d regulations of the State of Washington and
the City of Federal Way.
Owner or agent: Date: #7 /l-5
4110
THIS CARD IS TO REMAIN ON-SITE
CITY OF A Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-103319-00-EL
Owner: FWASC, LLC
Address: 34612 6TH AVE S Suite 100
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
are logged on the back of this card.
O Slab/Concrete Floor(4255) ❑ Ditch cover(4030) 0 Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date By Date By Date .
❑ Temporary Power(4275) ❑ Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date •
O Rough Electrical(4225) MI, Ceiling Cover(4020) ►: Final-Electrical(4055)
Approved Approved Approved
By Date By •R� Date R B *ii0 Date I ' 0
i
❑ Under-slab groundwork(4295)
Approved
By Date
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. PERMIT SF MF CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
333258TM AVENUE SOUTH•PO BO$Q7,)$ 1 r 2ooAPPLICATI0N
FEDERAL WAY,WA 98063•.977djUL TD / /
253-835-2607•FAX 253-835.2 - -
UMW.cityoffiderahnay.a m
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The ollowi Ill1 • bn incom•tete • ••lication will not be acce•ted. Please •rint le• - or t AI
• PROPERTY INFORMATION
SITE ADDRESS /�? / ,qW -
Ideal Gc7l0J3 SUITE/UNIT#
ASSESSOR'S TAX/ LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
( e0,9e.forI..9thN legal dexna5onl
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION iX ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT
DESCRIPTION(Provide detailed.escription of work included on this .ermit onl
PROJECT NAME(Name of Business or Owner Last Name) ( cele/4/ UA y A b'it ledery /
i El PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER &XS(&o( Crete\mss ( ) -
MAILING ADDRESS
Po /nq��/' CITY,STATE,ZI ///� /.../A//{A-
G/ll)e 3?o f31CLCtc alt-- oI1d ( /J 1
CONTRACTOR COM ANY NAME APPL.IWIT NAMEOFFICE PHONE
a>�ro( e(ec i _ Ke Uoyie (9-53) V7S - n5o
MAILING ADDRESS �i CIITTYSTATE,ZIP Q'Q'(�(/ CELL PHONE
/8617 3$'41 V -Ice,,,„,.EXP14 N J O J L(e (263 ) 677 -aocl
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
- _ B L I / ( ) _
CONTRACTOR'S REGISTRATION NUMBER(copy of cud cognized with each application) EXPIRATION DATE
/
APPLICANT COMPANY NAME APPLICANT
NAME OFFICE PHONE
Mato{ Lfckki.L poyk. P63) 17,5 Q/59
MAILING ADDRESS CITY,STATE,ZIPPHONE
18119 3 3 e 7a cow 4A-ityw6 (1253) 677 - 9,26q
RELATIONSHIP TO PROJECT / FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( ) -
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,.STATE,ZIP
• DETAILED BUILDING INFORMATION I 1
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
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/ ELECTRICAL PERMIT INFORMATION
( 3 IZS -c
RESIDENTIAL C () 2 2�OMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
•
Service or Feeder Each Add'n
❑ Single Family Square Feet
(First 1300 ft2-$104.50;Each add'n 500 ft2-$33.50) ❑ 0 to 100 amp $113.50 $69.50 J
❑ Detached outbuilding or garage 310i-200 amp Cr 89.00'$ (=
(Inspected with service) $44.00 1 201-400 amp `264.50 104.00
❑ Detached outbuilding or garage ❑ 401-600 amp 1 1.1 0 123.50
(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
❑ 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 ❑ it 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
MOBILE HOME/RV PARK Residential/Multi-Family $61.00
❑ #of service or feeders
(First service/feeder-$69.50;each add'n-$45.00) Commercial/Industrial Service or Feeder Ampacity
❑ 0-100 amps $69.50
❑ 101-200 amps 89.00
❑ 201-400 amps 104.50
❑ 401-600 amps 141.00
❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
)
❑ #of Thermostats ❑ #of Signs G1
(First-$52.00;add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea)
1
❑ Low Voltage ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s) (Includes additional circuit,if required) 9---
❑ Fire Alarm System ❑ Yard Pole meter loops $104.50
❑ Security Alarm System ❑ Additional Plan Review
❑ Voice Cabling $104.50/hour
(for modified submittals)
❑ Data Cabling
0 ❑ Automation Fee o. . - s $5.00
(Per System(s) le 2500 ft2-$61.00;
Each add'n 2500 82-16.00) •Per WAC 296-46-910(5)(b)(i&ii) , -
ea 6
Bulletin#100-January 7,2005 Page 3 of 4 andoutsWermit Application -
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT 0
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SP TOTAL ST
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHAIVICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercia) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(roue) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) 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(inciu• g costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim),which may be made by any person,includi "'the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reliance of the city,includi - its o rs and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE //si1� DATE
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent peontractor 0 Architect 0 Other
POR OFFICE UUSE oNLY
a NEW a ADDITION' ❑ALTERATION n REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? ❑YES a NO UP/SEPA/SU? a YES o NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application