05-103374 City of Federal Way 'Electrical Permit #: 05 - 103374 - 00 - EL
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718 O
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: FEDERAL WAY AMBULATORY SURGERY CENTER
Project Address: 34612 6TH�Av4,, Parcel Number: 926480 0010
Project Description: Wiring for low voltage fire alarm for 1st and 3rd floor
Owner Applicant Contractor
FWASC,LLC E-SQUARED SYSTEMS,LLC DANARD ELECTRIC INC
FWASC,LLC PO BOX 731227 18819 38TH AVE E
PO BOX 890 PUYALLUP WA 98373 TACOMA WA 98446-1142
BLACK DIAMOND WA 98010 (253)875-8650
Electrical Fixtures
Description Quantity Description Quantity]r Description „Quantityi,
Low Voltage Fire Alarm-Commercia 7600
PERMIT EXPIRES January 14,2006.
Permit issued on July 18,2005
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: f�/f /ti C-', `d Date: 7/41
`j`S
,O0.6,2,4,
......... ?
1t
ATHIS CARD IS TO REMAIN ON-SITE
CITY OF Community'Development Inspection Record-
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-103374-00-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
are logged on the back of this card.
0 Slab/Concrete Floor (4255) 0 Ditch cover(4030) ❑ 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
O Rough Electrical(4225) 0 Ceiling Cover(4020) ❑ Final-Electrical (4055)
Approved Approved Approved
By Date By Date By Date
❑ Under-slab groundwork(4295)
Approved
By Date
.. y
•Y.
CITY OF Oc 1�LG� 3 3
Federal Way
UL 1 2 2005 PERMIT SF MF CO M EL L DE EN FP
COMMUNITY DEVELOPMENT SERVICES ��
33325 8T"AVENUE SOUTH•PO BOX 9718 m / /
FEDE35 RAL WAY,WA 98.83-97609DF FEDERALAPPLICATION
253www.607•FAJC2wausco26'iiiii.bING DEPT,
www.eituoffederalwm.co,n Iv DE
The ollowin• is re.uired in ormation-an incom.fete a•.lication will not be acce.ted. Please •rint le.ibl (in ink)or .e.
• PROPERTY INFORMATION
SITE ADDRESS �CI Z (,,t1, A"- S SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 9 Z, 4" 9 L. - 0 0 1 0 LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach sepruute pageJor lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 ?LUMBING 0 MECHANICAL //,����JJ
❑ DEMOLITION ELECTRICAL 0 ENGINEERIN(�yJ �+'IRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only) ''/
/1/4,i i hrz._ A- G.r%„1 _s (-fr'rl i24/' (7/G^,"\--(
PROJECT NAME(Name of Business or Owner Last Name) C«”`( t,-,,,,, moi^�`. (ctft •7 c "i v
• PEOPLE INFORMATION
PROPERTY NAMEPRIMARY PHONE
OWNER C 'l-c(_416/Q- (.._rt:ril-i-j ii/L_( Ti ^''t (2`A--("V- ( ) -
MAILING ADDRESS CITY,STATE,ZIP
Pa 13v°fi S'`l0 (31o1GIL- Prco,0-1(), v./6 427K-0/0'- (.)g70
CONTRACTOR "OMPANY NAME r - APPLICANT NAME OFFICE PHONE �j
Da(v.r- r.�GGTrce--, I-,c - v Day(4 (2 ) E'75 —U6 v
MAILING ADDRESS CITY,STATE,ZIP — ICI l P1-0ONF.
i8g7161 38''`' Avg E mc..,...,k,-,p gvy(- (?s3) (.7'7- R2-o9
CITY OF FEDERAL WAY nU29NE5S LICENSE NUMBER - LxJI RATION DATE FAX NUMBER
1 °I - 1 9 -i s2 G 9. 3 - B L S / 3 I /2v06 (C2.s3)S'7S--86 '9
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
D A N E & k 1 l 1, K (xs S / 3/ / 2.666
APPLICANT COMPANY NAME /� APPLICANT NAME OFFICE PHONE
.St
E-s „i'1fJ' J`xjATm1/ �L t' 1---(-- t-1,-,--t-1,-,--)>.t-1,-,--)>. 2( o 8-'1b. - iocs
MAILIN ADDRESS CITY,STATE,ZIP CELL PHONE
1'c ✓;�'X 7.3/ s Z-7 piA7,,i(,1, �il/-s `)E-3-7,_._ ('Z.S (
� ) Sii. -6,s
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant 0 Agent Other(Describe) --C',/.1lI t--' ( '2-S3)k yl/ -_S yJt+)
CONTACT NAME -> PRIMARY PHONE E-MAIL ADDRESS
T -41 L- G)--,1k (2S3) 6,k - (, ,jefec c- 2_...c 'J frii1 (1c ,<<).-)
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
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE Li TACOMA ❑ PRIVATE(WELL) 0
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
sg.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
*"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.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS cconv,ereiall WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS or Thb/Showcr Combo) SHOWERS WATER CLOSEIS(Toilet) 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(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 e7v DATE 7A
) (ale)RELATIONSHIP TO Pt(i(S-4nature
OJECT 0 Owner ❑ Agent ❑ Contractor u Architect ❑ Other
FOR OFFICE USE ONLY
u NEW u ADDITION u ALTERATION ❑REPAIR L TENANT IMPROVEMENT
BUILDING SHELL ONLY? u YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? L YES o NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
•
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application
•
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
LI Family Square Feet Service or Feeder Each Add'n
(First 1300 ft2-$104.50;Each adds 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 U 401 -600 amp 308.00 123.50
(Inspected separately) $69.50 U 601 -800 amp 398.50 168.50
U 801 - 1000 amp 486.50 203.50
NEW MULTI-FAMILY(three units or more) U 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 U Mast or meter repair $96.00
❑ 401 -600 amp 193.00 96.00
ALTERED COMMERCIAL/INDUSTRIAL
U 601 -800 amp 247.00 132.00
❑ Over 800 amp 353.50 264.50 Service or Feeders
U Oto 200 amp $113.50
ALTERED SINGLE/MULTI FAMILY U 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
U 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
U 101 -200 amps 89.00
U 201 -400 amps 104.50
❑ 401 -600 amps 141.00
U over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats ❑ #of Signs
(First-$52.00;add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea)
U Low Voltage U Swimming pool/hot tub $87.00
Square Feet to be served by system(s) (CJ✓ (Includes additional circuit,if required)
la Fire Alarm System U Yard Pole meter loops $104.50
U Security Alarm System U Additional Plan Review $104.50/hour
0 Voice Cabling
(for modified submittals)
O Data Cabling
❑ U Automation Fee on all Permits .. $5.00
(Per System(s) la 2500 ft2-$61.00;
Each add'n 2500 ft2-16.00) •Per WAC 296-46-910(51/b)(i&ill
Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application