03-105345 rCity ueral Way
Communitynity Development Services Electrical Permit #:03 - 105345 - 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: ST FRANCIS SURGERY AND LAB
Project Address: 34515 9TH 2 Qt S Parcel Number: 750451 0020
Project Description: TI for lab remodel and portion of surgery remodel.
Owner Applicant Contractor
Hospital Bsp StFrancis Hospital Bsp StFrancis VECA ELECTRIC CO INC
2002 ADV DEP PD 5282869 2002 ADV DEP PD 5282869 PO BOX 80467
SEATTLE WA 98108
• (206)436-5200
Electrical Fixtures
..... ___ _ . `tcr
Re rip .. ._'.. .� 4 �! i atic n. � rQuantity
Alt.Serv./Feed 201 amps-600 amps-r 1 Low Voltage-Other Commercial 7500
PERMIT EXPIRES September 18,2004.
Permit issuedon March 22,2004
I hereby certify that the above information is correct and that the co cton on the above described property and
the occupancy and the use will be in accordance with the laws,rule and regulations of the State of Washington and
the City of FederalWa.
Owner or agent: i f 'j ,�f Date: sE^22
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, RECEIVED I 2. _ a di-d l �C ,
'�, CONSTRUCTION ERMI APPLICATION
G:TY OFi ./ APPLICATION NUMBER:
Q _ 1 v
Federal Way DEC 0 8 2003
APPLICATION NUMBER:
CITY OF FEDERAL WAY (APPLICATION NUMBER: - -
BUILDING DEPT.
**The following is required information-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
A
e''.PROPERTY INFORMATION
9�
A
SITE ADDRESS:3 "r� " / 4 e/E 0 40 V/ ASSESSOR'S TAX/PARCEL #: -
c6-oE4..?c. w.rr ti.,¢. yro 03
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
I'►1 PROJECT INFORMATION -
TYPE OF PROJECT(This application): )(..
o
BUILDING o PLUMBING o MECHANICAL 0 DEMOLITION
ELECTRICAL ,r❑-ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): `C�r�'f C'r o— To
`f("lye". rrnr TES,--7.,,7 .6.4.,,,v/t,."e".-tter.� ✓ 7-0,
7We lef, A.--A-0 di ve ✓ /bit.!.xi,_ a,-
rev 6 fi,.i.-6671..7 -, ..ec.
PROJECT NAME:S/' 4 Pit ^ C47X f(-A f�dh-7 `"4 6 ,or>ct 4, eEC
11 PEOPLE INFORMATION
PROPERTY OWNER: NAM : : DAYTIME PHONE
i .4,-Grp'c.f.,- I(6/41 c'Mt '-f17s i c(`'.•,. 1 i,2,Ty )ice 4 -6a'.3(7.
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): I
17/7 J'o. " T" ✓-744'7 7,*c...•,.s k...4 , 7c3'ro/-Z'7 7
CONTRACTOR: -ME: DAYTIME PHONE: i
I G -' A — )
MAILING ADDRESSSSTREET•a a-•-, ,--•. STATE.ZIP): EVENING PHONE- —
a F Ca..,r/+f-c,r fir., /' - _/l t-c it-- Cif ( ) i
CITY O EDA yJAY BUSINESS LICENSE NUMBER: _ �' - ` FAX NUMBER: -
/``'Yrj/Ir ( )
CO CTORS REGISTRATION NUMBER: 1 EXPIRATION DATE: 1
(copy of card required) { / /
APPLICANT: NA ' _ DAYTIME PHONE:
M1• f "ce.-c.Zf 11Of/y/4tC ( ) i
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE
V7/'7 fo - ,•J.�' r1,tc� jeK'o,„,#. L.„4, 9,yy•/-02/97.(..2S3 )y.2.` -‘6,3r
I RELATIONSHIP TO PROJECT: j FAX NUMBER:
o ARCHITECT 0 TENANT o OTHER ( DESCRIBE): (,213)Yo2L '' ‘6 7r
E-MAILDDRESS: ^ 1
,rr64'LNi(It.�vl—'!��✓Kl
CONTACT PERSON FOR THIS PROJECT: r13.440PERTY OWNER o'(PPLICANT 0 CONTRACTOR Ch .-s—Co.-
: 1 .
I
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXI NG BUILDING ASSESSED/APPRAISED V• i ATION
PROP•'c I USE: •ROPOSED VALUATION FOR IM •OVEMENTS: $ A
SPRINK ERED BUILDING? o YES o NO FIRE SUPPRESSIO YSTEM PROPOSED/R:•UIRED:0 YE• 0 NO
WATERS RVICE PROVID ': o LAKEHAVEN 0 HIt LINE ❑ TAC A ❑ PRIVATE(WELL) '
SEWER SE•VICE PROV •ER: 0 LAKEHAVEN 0 HIGHL • . •RIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ 1
■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. ` TOTAL
B• ENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK //'
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
Indicate number of each type of ' re
MECHANICAL Value •f Mechanical Work: $
AIR HAN 1 t G • IT(S) EVAPORATIVE COOLER(S) GAS L• ) REFRIG.SYSTEM(S)
BBQ(S)� FAN(S) HOOD(S) WOODSTOVE(S)
BOI (S) FIREPLACE INSERT(S) RANGES) MISC.( )
CO •R :s R(S) FURNACE(S)
DUCT( GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ECTRIC ❑GAS
PLUMBING
ATHTUB(S) LAVATORY(S) URINAL(S) WA • HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
Pi DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury tha 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,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information supplied the city as a part of this application.
NAME/TITLE: "' /LO is Cg_f%2v��,d!". 6 DATE: /o2 4),.?
I ROPERTY OWNE teAPPLI NT ❑CONTRACTOR
..FOR,OFFICE USE ONLY:
"O„NEWS. xp ADDITION . �„O ALTERATION ,n REPAIR 0 TENANT IMPROVEMENTS Fa
'CENSUSLOT SIZEf:,., .3 r;K, ..,,.
ZONING,DESIGNATION, _ ” .BUILDING SHELL ONLY?' U YESiL :c NO
COMP PLAN DESIGNATION ! ':11 ASIC PLAN? DYES ❑"NO'
`SECTION 14 ,.e+ TOWNSHIP_ti'� ,°RANGE 'Y , .NEW ADDRESS REQUIRED? x "❑YES o NO
;PLAATTED'LO-4? _!,'❑YES n NO '." r�', _76'•CHANGE OF USE? ., =-.o YES``'=0 NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www•cityoffederalway.com
TABLE B
NEW RESIDENTIAL SERVICES MO: - HOMES - MISC EQUIPMENT/TEMP SERVICES
Sia Family -_Servi .or feeder only .. .57.00 _#of Thermostats(First-$43.00;add'n-$13.O0ea)
-
(First 00 ft'-$85.50;Each add'n 500 -'•27.50) Service .•d feeder $93.00 _#of Low voltage fire or burglar alarms FF
Square Feet. _ First 2500 ft'-$50.00;Each dd'n 2500 ft`-$13.00 f
_Each outbuildi or garage.. $35.50 MOBILE HOME •V '•RK Square Feet:7j f && 40 Ga1p(.I vt•ar
(Inspected with Sc 'cc _#of service o - ers *Per WAC 296-46-910(5)(b)(i&ii) i •'
_Each outbuilding r :a :-e $57.00 (First se ' e/feeder-. 7.00;Add'n service/ _#of Signs(First sign-$43.00;add'n sign
(Inspected se.. ately) fe , r-$37 each) $20.00 each)
I _Swimming pool,hot tub,spa $85.50
I _Yard Pole meter loops $57.00
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL
(Includes three units or more) Altered Service or Feeders
Service ' eder Amps Service or Add'n acto 200 i 93.: i -
Up Oo amp $ 93.00 _5 27.50 Feeder 201 -600 C216.50 ;
201 -41 .mn 115.50.. 57.00 Oto 100 5 93-00 $ 57.00 601 -1000 126.5' I
-401 -600 an • 158.51 78.50 _101 -200 115.50 72.50 =
- over 1000 363.0',
601 800 amp 21 . 0 108.50 X201 -400 216.50 85.50 #of circuits
_Over 800 amp .... 89.50 216.50 _401 -600 252.50 101.00 1I-5 circuits-$72.50:Add'n circuits,S6 ea/
ALTERED SINGLE/MU AMILY _601 -800 326.50 138.00
(When inspected se.. ately .m the services.) _801-1000 399.00 166.50 TEMPORARY SERVICE A://,4
Service or Feeder _Over 1000 434.50 232.00 Residential/Multi-Family/Commercial/Industrial
=0 to 200. • $ 71.50 _Over 600 volts surcharge 72.50 0-100 $ 57.00
201 -61..amp 115.50 _Mast or meter repair 78.50 _101 -200 72.50 •
_over:10 amp 174.00 201 -400 85.50
N . t or meter repair .43.00 _401 -600 115.50 ; ,
• of circuits _over 600 125.00
(1-4 circuits-$57.00;Add'n circuits$6 ea)
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+$72.50.Add'I plan review for other submissions is$85.50/hr.
i
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLES(B) NUMBER OF UNITS(C) TOTAL(D)
• I
�,�# / 3 % ivAt!r./�75..-- y/,2 - C�7X 7) // s'3b'.'
IOL.- V C 44r 4.,fe 74 /3 I _ �4 ,2(2.. ; 7/ sOe C./ - 7‘. 00
>41^/). w Aa
.. co_ se o i - ce-• Ca o2° t - / t•,Te
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c7Iems► ,rte =mac j a c,- ate • - ?J-
TOTAL COLUMN(D): /, f.2..?. r• l
Total Column ID)
4 / 9a 3. .!"Q
Estimated Permit Fee: (12) /
Estimated •
� Permit Fee from line 12
111
Estimated Plan Review Fee: $72.50+ ( �1Y I/ 9•-3•S • X.35) = (13) 7_7
- ■ DEMOLITION -
Estimated Permit Fee: (14)
Bond Amount:(15)
• EN.GINEERING .: .
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)
Bulletin rt 100-December 23, 2602