04-103603 City ueveWay
Community Development Services Electrical Permit #:04 - 103603 - 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: PAIN CENTER OF WESTERN WASHINGTON
Project Address: 34509 9TH1S UNIT203B Parcel Number:
Project Description: Cabling for voce and data
Owner Applicant Contractor
ST FRANCIS MEDICAL CTR ASSOC.*ST FR ESCHELON TELECOM INC ESCHELON TELECOM INC
1717 S J ST ESCHELON TELECOM INC ESCHELON TELECOM INC
TACOMA WA 98405-4933 13035 GATEWAY DR SUITE 119 13035 GATEWAY DR SUITE 119
TUKWILA WA 98168 (206)242-1400
Electrical Fixtures
I Description (Quantity Description Quantity Description Quantity
Low Voltage-Other Commercial 1000
PERMIT EXPIRES March 7,2005.
Permit issued on September 8,2004
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: Q _ . Date: I iy i
THIS CARD IS TO REMAIN ON-SITE
A
�� of Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-103603-00-EL
Owner: ST FRANCIS MEDICAL CTR ASSOC.
Address: 34509 9TH AVE S UNIT 203B
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) 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) N, Final-Electrical(4055)
Approved Approved Approved
By Date By Date By gkilf Date t - 0 L❑ Under-slab groundwork(4295)
Approved
By Date
, . .A
CRY OF 'T"3VED I V 2 03
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO M PL DE EN
33530 FIRST WAY SOUTH BOX 9718 APPLICATION' ' B l7 .rD
FEDERAL WAY,WA 98063-9718
253-661-4115•FAX 253-661-4129 TD / /
www.cituoffederalwau.corn
\,11,',Y
CITY Oc LID:
The ollowi • is re•uired in ormation-an incom•lete a• •lication win not-ne`acre•ted. Please •rint le•ibl in in or •e.
�11 }may � PROPERTY INFORMATION r�
SITE ADDRESS 3'4 50°1 "19:41 �J t • S. SUITE/UNIT# o)63,13
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 ❑ BUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION X ELECTRICAL o ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed descrip ion of work included on this permit onitU
('t�.bll4j 1 1.)01c,,2_ avid • koz� Uol-f-�7xL. •
.J
PROJECT NAME(Name of Business or Owner Last Name) r 1,_�..z 4- Q9-c54-e Irl tS
PEOPLE INFORMATION
PROPERTY NAME j ,t,...- PRIMARY PHONE
OWNER • t fanCi S uC.J q ASS-0 C- (05555 z -i llew
MAILING ADDRESS CITY,STATE,ZIP
p•o• 88x -7 lore_ ‘A, u.or 9 c LI DI- a1 7
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Esc,he on-1e l ek6m I4frea. kesti,Q_ e rw ) (nolo ) a(101 1400
MAILING ADDRESS Jie. CITY,STATE,ZIP CELL PHONE
I SD 35 IewcLA A li.I. \VI° Tv..kUJ11 ct lsJ)4 CI i I Q� (a(tID ) Bos - a-1-3(
CITY OF FEDERAL WAY BUSINESS LI NSE NUMBER EXPIRATION DATE FAX NUMBER
S °1- 9 9 - 14 k 6 lQ- B L a i 3/ i ooaq (act) ws -socr a
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
CS c H E T & o o o L 8 t)71 i 9 i cR(°tp
APPLICANT COMPANY NAME PLICA T NAME OFFICE PHONE
(Alin Ce 4-er off'`A -ss-4Ri',n nn PLICA
bVid Vel�nc (3tjO) 543 -7197
MAILING ADDRESS r' c 3 -'[CITY,STATE,ZIP /'�I I I,'�e /50 ((CELL PHONE
;3 'Jc ca P-UG S. eAer Ofit{, W/- (AX NUM)ER
RELATIONSHIP TO PROJECT �J
0 Architect f Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT 1 NAM PRIMARY PHONE E-MAIL ADDRESS
I I1 vel�n• (3t�o ) 7'13 �] 7 drdvettn Pewliead•ald
LENDER s 2947 Ogg Lentier t' n is NAME 9
'7°1°4'4fl ject value excsetde a4 r0
MAILING ADDRESS CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA o PRIVATE(WELL)
, SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture 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 GAS LOGS REFRIG.SYSTEMS
COOLERS
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 SHOWERS WATER CLOSETS MISC(Describe)
Combo) (Toilet)
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 9fficers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
—
/1
qq V T
NAME/TITLE ,,
/�t I ( DATE I(�
(Signature) (Title) i I V
RELATIONSHIP TO ROJECT o Owner ❑ Agent 45 ntractor ❑ Architect ❑ Other
FOR OF ... Y
'1 _.;9- %ii,.,
❑NEW a ADDITION ❑ALTERATION a REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES a NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\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-$87.00;Each add'n 500 ft2-$28.00) U 0 to 100 amp $ 94.50 $ 58.00
❑ Detached outbuilding or garage ❑ 101-200 amp 117.50 74.00
(Inspected with service) $36.50 ❑ 201-400 amp 220.50 87.00
❑ Detached outbuilding or garage ❑ 401-600 amp 256.50 103.00
(Inspected separately) $58.00 ❑ 601-800 amp 332.00 140.50
NEW MULTI-FAMILY(three units or more) ❑ 801 - 1000 amp 405.50 169.50
Service Feeder ❑ Over 1000 amp 442.00 236.00
❑ Up to 200 amp $ 94.50 $ 28.00
❑ 201 -400 amp 117.50 58.00 ❑ Over 600 volts surcharge $74.00
❑ 401 -600 amp 161.00 80.00 ❑ Mast or meter repair $80.00
U 601 -800 amp 206.00 110.00 ALTERED COMMERCIAL/INDUSTRIAL
U Over 800 amp 294.50 220.50
Service or Feeders
ALTERED SINGLE/MULTI FAMILY U 0 to 200 amp $ 94.50
❑ 201 -600 amp 220.50
Service or Feeder ❑ 601 - 1000 amp 332.00
❑ 0 to 200 amp $ 72.50 ❑ over 1000 amp 369.50
❑ 201 -600 amp 117.50
U over 600 amp 177.00 ❑ #of circuits to be added/altered
(1-5 circuits-$74.00;Add'n circuits,$6.00/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$58.00;Add'n circuits$6.00/ea)
$74.00 plus 35%of Permit Fee
❑ Mast or meter repair $43.50 ❑ Service over 200 amps
❑ Medical/Educational/Institutional Facility
SINGLE/MULTI FAMILY PLAN REVIEW
❑ Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES
U Service or feeder only $58.00 TEMPORARY SERVICE
❑ Service and feeder $94.50
Commercial Residential
MOBILE HOME/RV PARK U 0- 100 $58.00 $51.00
❑ #of service or feeders ❑ 101 -200 74.00 51.00
(First service/feeder-$58.00;each add'n-$37.50) ❑ 201 -400 87.00 n/a
U 401 -600 117.50 n/a
❑ over 600 127.00 n/a
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats ❑ # of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ea)
14 Low Voltage ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s) t ODD St• (Includes additional circuit,if required)
❑ Fire Alarm System U Yard Pole meter loops $58.00
❑Sec urity Alarm System U Additional Plan Review $87.00/hour
voice Cabling (for modified submittals)
Data Cabling
0
(Per System(s) 1s,2500 ft2-$51.00;
Each add'n 2500 ft2-13.50) Per WAC296-46-910(5)(b)(i 8c ii)
Bulletin#100-March 30,2004 Page 3 of 4 k\Handouts-Revised\Permit Application