03-105036 •
14011011.664.
City of Federal Way i
Community Development Services Electrical Permit #:03 - 105036 - 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: FRANCISCAN WOMEN'S HEALTH CENTER
Project Address: 34503 9TH S -(,,3 Parcel Number: 750451 0050
Project Description: Electrical work for tenant improvements including electrical demolition and low-voltage voice/data
cabling.
Owner Applicant Contractor
MEDICAL REAL ESTATE SVCS FRANCISCAN HEALTH SYSTEM/CHI NONE
1501 4TH AVE 1717"J"ST
SEATTLE WA
98101-3225 \TACOMA WA 98405
Electrical Fixtures
Description Quantity Description Quantity Description 11Quantity1
Alt.Serv./Feeder:0 to 200 amps-Res. 1 11 Low Voltage-Other Commercial 1 3822
II
PERMIT EXPIRES August 22,2004.
Permit issued on February 24,2004
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. A��� , L __ Date: p..,LtINLJ
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hh CONSTRUCTION PERMIT APPLICATION
CITY OF �1 APPLICATION NUMBER: 03_ - /Q S-0 3 (0- .-
Federal Way APPLICATION NUMBER: -
RECEIVED rAPPLICATION NUMBER: - -
*'The following is required information-Please print(in ink)or type*'
NO V r bWl ea'�7e? J: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
a PROPERTY INFORMATION
SITE ADDRESS: ,� / -0--3 • 9 7 4 /4t w` . f0 4 ASSESSOR'S TAX/PARCEL #:7 s"--o y S-I - C7 a S— 6
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
Ls r 7.-- /IC C 2 J7, f/L.�,.—c.7,r ALo„ ,.t%rc —00-,
• ■ PROJECT INFORMATION .
TYPE OF PROJECT(This application): o BUILDING ❑ PLUMBING 0 MECHANICAL o DEMOLITION
(ELECTRICAL 0 ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): G eec r40'..„r-c__ /9 6/i't p ?^�—
dn-if 16,--dr”-e -7-"Lf rie$v c:-,-(4 s...-f e {APfgrr
-
Gv�/11 r, /6-/qc fE ce."4,7e-i.. dao 2 -7, 7-001-e-
4
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6w.r--c'v-C p�.xc B' firc--=c0-- i- (—V T
v b"Wk" .-// Y o 1 Le- C 210 ( .-t.
PROJECT NAME: Pt/ Oh 4,-,-- ',- / 4CTsr4 Com,--e / -/4-1 O AP ere_
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: ; DAYTIME PHONE
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
s—c/ c-f For- l e, fe'Crirrrer /G/
CONTRACTOR: NAME: , DAYTIME PHONE:
Q
j.6.--//6..I.---. CO".✓ cr-
T/Z*G. rem IP / ! (2o6 ) Yo Sr- 71/7
eL C- I MAILING ADDRESS(STREET ADDRESS;CITY,STATE.ZIP): ��. EVENING PHONE:
�! l 1I O_ ,f ex 7' 70 cre/rf7l,r ( 4t 9UO? ( )
eI CITY OF FEDERAL WAY BUSINESS UCENSE NUMBER: FAX NUMBER:
Or «r - ( ) -
CONTRACTOR'S REGISTRATION NUMBER: I EXPIRATION DATE:
(ropy of card required) O^', / CEe / /
APPLICANT: NAME: DAYTIME PHONE:
-S % . f/104,--c. .ralJy.F:.*C (.2s3 ) ?d2 4 - B'3s"
MAILING ADDRESS(STREET ADDRESS;CTT TE, IP): EVENING PHONt:
f /7/7 S.°. ' J' K .J "/t 6aT 7efcde''.A i ( 700/ ( )
RELATIONSHIP TO PROJECT: j FAX NUMBER:
0 ARCHITECT TENANT ❑ OTHER(DESCRIBE): (2,r3) 9-24 - 6° 737
E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER t APPLICANT 0 CONTRACTOR.74/C/f / TO.-'• Gf�t Il'v6 �•
CAO/ere
.■ DETAILED BUILDING INFORMATION
EXISTING USE:/t1 e 'c. ' O/-ICr'EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
/lj v.Cc#04- C
it PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
_. 1 • r
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
. ■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL Value of Mechanical Work: $
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: o ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC a 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,induding 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 suppli•• • the dty as a part of this application.
NAME/TITLE: /�, ,. _ "L/S go~ DATE: //- 7—
o PROPERTY OWNE• q(APPLICA T o CONTRACTOR
,,FOR OFFICEUSE ONLY:I
NEW ` p.ADDmof'l .i]ALTERATION:®;REPAIR �b�TENANT.IMPROV....EMENT � moi.:
CENSUS;`CODE
#01049::P4401#1:60);:;-;-'
BUILDING SHED ONLY?��`oYES�❑NO �� ,_ . '.
COMP PLAN DESIGNATION wn "' ' "-..'04*
��� ,� , �1BASIC PLANMo YES �--
sECTION .4TOWNSHIP 'RANGEANEW ADDRESS
PLATTED LOT? 'yES a;NO �r . CHA'�NGE'OF�USE? ;x„ ; ,�o YES ' `NO ry
•
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
�' www.dtvoffederalwav,com
■ ELECTRICAL
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family Service or feeder only $57.00 _ Thermostats of Thetostats(First-$43.00;add'n-$13.00ca)
(First 1300 ft2-$85.50;Each add'n 500 ft'-$27.50) _Service and(ceder $93.00 _ft of Low voltage fire or burglar alarms
Square Feet: _ first 2500 ft'-$50.0gEaadd'n 2500 ft2-$13 0(;
_Each outbuilding or garage $35.50 MOBILE HOME/RV PARK Square Feet: 50
(Inspected with service) _ft of service or feeders ' Per WAC/296-46-910(5)(b)(i&ii)
_Each outbuilding or garage $57.00 (First service/feeder-$57.00;Add'n service/ _ft of Signs(First sign-$43.00;add'n sign
(Inspected separately) feeder-$37 each) - $20.00 each)
Swimming pool,hot tub,spa $85.50
l _Yard Pole meter loops $57.00
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL 132 1 517
(Includes three units or more) Itered Service or Feeders
Service Feeder Amps Service or Add'n 0 to 200. 5 93.00
_Up to 200 amp S 93.00 $ 27.50 Feeder I -.10 216.50 's
_201 -400 amn 115.50 57.00 0 to 100 5 93.00 $ 57.00 _601 -1000 326.50
_401 -600 amp 158.50 78.50 _I Ol -200 115.50 72.50 _over 1000 363.00
_601-800 amp 202.50 108.50 _201 -400 216.50 85.50 _It of circuits
_Over 800 amp 289.50 216.50 401 -600 252.50 101.00 (1-5 circuits-$72.50;Add'n circuits,£6 ear
ALTERED SINGLE/MULTI FAMILY _601 -800 326.50 138.00
(When inspected separately from the services.) _801 -1000 399.00 166.50 TEMPORARY SERVICE
Service or Feeder _Over 1000 434.50 232.00 Residential/Multi-Family/Contmerciai/Industrial
=
0 to 200 amp $ 71.50 _Over 600 volts surcharge 72.50 -O- 100 5 57.00
201 -600 amp 115.50 _Mast or meter repair 78.50 _101-200 72.50
over 600 amp 174.00 201-400 85.50
_Mast or meter repair 43.00 _401-600 115.50
I _#of circuits _over 600 125.00
(1-4 circuits-557.00;Add'n circuits$6 ea) I
i
If 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+572.50.Add'I plan review for other submissions is$85.50/hr.
FIXTURE DESCRIPTION(A) FIXTURE.FEE FROM TABLE B(B)r : NUMBER OF UNITS(C) TOTAL(D)
i
i I
i i + 1
TOTAL COLUMN(D):
Total Column(0)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $72.50+( -X.35)= (13)
. . - ■ DEMOLITION -
Estimated Permit Fee: (14)
Bond Amount:(15)
■ ENGINEERING -- - - , -
Estimated Permit Fee: (16)
Bond Amount: (17)
. - ■ OTHER FEES -- . • :.- ---
Mitigation Fee: (18) (20) (22)
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)
• 4--
Bulletin #100-December 23, 2002