05-104842 City of Federal Way Electrical Permit#: 05 - 104842 - 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) 835-3050
Project Name: FEDERAL WAY AMBULATORY SURGERY CENTER
Project Address: 34612 6TH1S Suite100 Parcel Number: 926480 0010
Project Description: Install low voltage nurse call system
Owner Applicant Contractor
FWASC,LLC COMMERCIAL SOUND,INC COMMERCIAL SOUND,INC
FWASC,LLC 2732 FIRST AVE S 2732 FIRST AVE S
PO BOX 890 SEATTLE WA 98134-1822 SEATTLE WA 98134-1822
BLACK DIAMOND WA 98010 (206)762-8903
Electrical Fixtures
00s ription (Quantity Description,:- Quantity Description [Quantity
Low Voltage-Other Commercial 6000
PERMIT EXPIRES March 20,2006.
Permit issued on September 21,2005
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. ,_, \ /NO'S —
\ 91 Owner or agent: sefi PPtlCJT1o3 Date:
�� f
THIS CARD,IS TO REMAIN ON-SITE
CITY OF 4, - - Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-104842-00-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) 0 Ditch cover(4030) ❑ 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 2 By Date By Date L❑ Rough Electrical(4225) 0 Ceiling Cover(4020) El Final - Electrical (4055)
Approved Approved Approved
By Date By Date By Date
0 Under-slab groundwork(4295)
Approved
By Date
RECEIVED BY
COMMUNITY DEVELOPMENT DEPARTMENT
t P 9 Z TMMC
CITY OF
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME 'L DE EN FP
33325 8n, .0[71791•PO BOX 9718 APPLICATION wr
FEDERALDERAL WAY.WA 98063-9718
1D
253-835-2607•FAX 253-835-2609
w w w.ci hio ffederalwal,com
The allowing is re•uired i ormation-an incomplete application will not be acce•ted. Please •rint le•ibl (in ink)or ty•'.
• PROPERTY INFORMATION
SITE ADDRESS %,21/7(70 (5 E -' ' SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(s/)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descapllon)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING Li PLUMBING 0 MECHANICAL
.7 DEMOLITION A ELECTRICAL 0 ENGINEERIPNG LI FIRE PREVE\TION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
P/2-00/0E ,4A10 //VS 779-LL is-C)(4) e)0C-779i E /3G!2Se- A LL
7E/97 FOS ic-I o O,9*/ 4jnnci At z-ol y ('G/d.J,(7
PROJECT NAME(Name of Business or Owner Last Name) /i 14)9/�/1/3aL..9--n9/2-76-1-1,41/e
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR 51MPANY NAME APPLICANT NAME OFFICE PHONE
5414,o,e4qa...),-16,17"
m,i75iee// C. •-liu v0 . ,n,' 1c ,l ci.c-si4cS )74'o2. -oyQ3
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
773 ,2 #h5r f6 - LJA173'/_ (.14 . ) 5? WO0
CITY OF FEDERAL WAY BUS ESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
i 1-3 -_1 Q ci 2 0 0-B L is / 5/ /mss ) 763 -&q9
�L��CQTRA 'S REGISTRATION NUMBER(copy of card required with each EXPIRATION DATE
dQJ eo ✓- IO7_,. /v'M/
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑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 PHONE
( ) -
U DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? YES i NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? YES NO
WATER SERVICE PROVIDER LAKEHAVEN n HIGHLINE -I TACOMA E PRIVATE(WELL)
SEWER SERVICE PROVIDER LAKEHAVEN , HIGHLINE - PRIVATE(SEPTIC)
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❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type o/fixture to he 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 OUTLRI ,
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS mile) 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/SIGNTURE BACK
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 ncluding costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim),which may be m e by any perso inc ding the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reliance of c'ty,includi g its tcers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE/ 01 5 DATE
ignature) (Title)
RELATIONSIIP TO PROJECT ❑ Owner 0 Agent )(Contractor 0 Architect ❑ Other
FOR OFFICE USE ONLY
❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? n YES ❑NO DEMO PERMIT REQUIRED? a YES ❑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
❑ Single Family Square Feet Service or Feeder Each Add'n
(First 1300 ft2-$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 398.50 168.50
❑ 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 metes 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 ❑ 201 -600 amp 264.50
❑ 601 - 1000 amp 398.50
Service or Feeder ❑ over 1000 amp 443.50
❑ Oto 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
Cl 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 Ampac:.:)
❑ 0- 100 amps $69.50
❑ 101-200 amps 89.00
❑ 201-400 amps 104.50
LI 401-600 amps 141.00
❑ 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)
Low Voltage /� ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s) QV (Includes additional circuit,if required)
O Fire Alarm System ❑ Yard Pole meter loops $104.50
❑ Security Alarm System /')/ ❑ Additional Plan Review $104.50/hour
❑ Voice Cabling /r/ (for modified submittals)
❑ Data Cabling 2
C o�r�.�vt .d�, , L U Automation Fee on all Permits $5.00
(Per System(s)1s,2500 ft2-$61.00;
Each add'n 2500 ft2-16.00)•Per WAC 296-46-91015)Ib)/i&W
Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application