05-104357 g City of Federal Way Electrical Permit#: 05 - 104357 - 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: GROUP HEALTH
Project Address: 301 S 320TH Jr Parcel Number: 172104 9105
Project Description: Installation of new recepticle in main waiting area behind lab reception for ticket machine.
Owner Applicant Contractor
GROUP HEALTH COOP&PUGET*GROUP] PRIME ELECTRIC INC PRIME ELECTRIC INC
521 WALL ST 13301 SE 26TH ST 13301 SE 26TH ST
SEATTLE WA BELLEVUE WA 98005 BELLEVUE WA 98005
98121-1524 (425)747-5200
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Circuits- Commercial 1
CONDITIONS:
This parcelislocated within a Wellhead Protection Area(Capture Zone 1)and must comply with FWCC,Chapter 22,
Article XIV"Critical Areas"and fill out a Hazardous Materials Inventory Statement,if applicable.
PERMIT EXPIRES February 22,200
Permit issued on August 26,2005
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use e in accordance with the laws,rules and regulations of the State of Washington and
the City of Federal W . C~
Owner or agent: �' i C>4-6;1—
Date: 096
FINALED
G 'S/
( ' 0
~44
THIS CARD IS TO REMAIN ON-SITE
CITY OF 111. Community Development Inspection Record -
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-104357-00-EL
Owner: GROUP HEALTH COOP & PUGET
Address: 301 S 320TH ST
FEDERAL WAY, WA 98003-5200
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) 0 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
❑ Rough Electrical(4225) ❑ Ceiling Cover(4020) ❑ Final-Electrical(4055)
Approved Approved Approved
By Date By Date By C c Date / —z 2—cv
❑ Under-slab groundwork(4295)
Approved
By Date
e RECEIVED
�ln� Q5 - 10 _ 3_ 5 Z
Federal Way PER5121611"5
SF MF CO ME dP'L DE EN FP
COMMUNfIYDEVELOPMENT SERVICES
33325 8rif AVENUE •PO BOX 9718 APP L`1 IM
FEDERAL WAY,,WA WA 9 98063-9718 7fl
253-835-2607•FAX 253-835-2609
www.cityoffederalway.corn
The ollowin• is r •wired in ormation-an incom•lete a, •lication will not be acce'ted. Please 'rint le•ibl (in ink)or • .
f53�J/� • PROPERTY INFORMATION
SITE ADDRESS ��` IJV SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - _ _ LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
---r-A-S-txs.I t At ®tAi-1 e+ ti A Mai vi 1n'a l t v./ be Imo,:1.4 LA b
rcc...etAi 0h A t 4-t.clod- JAA.0,e_l•.:tA.4
PROJECT NAME(Name of Business or Owner Last Name)
• PEOPLE INFORMATION
PROPEROWNER TY NAME/1 (01-le(:,t-{V) PRIMARY PHONE
� -
MAILING ADDRESS CITY,STATE,ZIP
301 S 31.04`" f ersJ t,06-1
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
PRAII,AZ CI tGfi.; t. Jav+vz-5 LeAPti eS S (`#2S) 741 - 5v,6
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
13 3O( SE w--1-L 54- gel!eV' p. fair( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Z. 0 - 0 0 — 1 0 ( 1 Z- B L /7/ 3( /05 (q25 )'71 -5552
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
Ple. "11�t e e' l L 3_ L' B - t / 30 / a7
APPLICANT CAPANY NAME APPLICANT NAME OFFICE PHONE
rim,-t 1 c ,arae-5 L ue(ts5 (475) 7'h - 5206
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
1336 f S21/41 Si- Blleti ct WA q 5- ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant ❑Agent 0 Other(Describe) ( q'$) 74, - S62..
CONTACTP PHONE E-MAIL ADDRESS
�A Lem less (q2-6) 7�/7 -.x'210 jaMes !(ter: .e efcc46e.•La
LENDER Per RC 7"
19.2095 Lender informationis 1; NAME
s required tfrxxdect value exceeds$5,000
MAILING ADDRESS COY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES ❑ NO •
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 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❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EMS/MD* TOTALS?.
PROPOSED SP 3 TOTALS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number ofeachtype o urture to be installed or relocated as part of this project. .,. efixtures
.. _._.. in
f f t. Do not include existingres 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 OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(meet) 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 o he city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE C(jDATE V{�Uff JL
(Signature) (Title)
RELATIONSHIP OJECT ❑ Owner ❑ Agent ,ontractor 0 Architect ❑ Other
FOR SE ONLYteo-
a'NEW a ADDITION a ALTERATION ,- '"a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN?- n YES a NO
ZONING DESIGNATION
; ,'CHANGE or USE? TES a NO
NEW ADDRESS REQUIRED? a YES a NO ;- UP/SEPA/SII a YES a NO
PLATTED LOT? a YES a NO DE 4l O PERMIT REQUIRED? a YES ti 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
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
❑ 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 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
❑ 0 to 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
U 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
U 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
(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) (Includes additional circuit,if required)
❑ Fire Alarm System U Yard Pole meter loops $104.50
❑ Security Alarm System U Additional Plan Review $104.50/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
❑ Automation Fee on all Permits .. $5.00
(Per System(s) tat 2500 ft2-$61.00;
Each add'n 2500 ft2-16.00) 'Per WAC 296-46-910(5)@)(t&ip
Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application