01-102230 ����
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���F � CONSTRUC, � �ON PERMIT APPLICATION
�V Ry�— ���1�M �;��¢� � � �';';�;� PPLICATION NUMBER: � _�- l O Z Z�Q - CO
\���" PPLICATIUN NUMBER: - -
��� ����Ue�.Cis€�����T�xY PPLICATION NUMBER: —
� � ��,' - - - - - - - - - - - -
�"1 � ` **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.
. � . , . .
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SITE ADDRESS• ASSESSOR'S TAX/PARCEL #:�,�"_p �[,f-Lt9Q�YJ = �� _
��E,t.�c 1�.,,•t7 /,,.,.� _ � 7 ,�a Y�'!' - O a 70 _ Op
LEGAL DESCRIPTION OF SUBJECT PROPERTY ATTACH SEPARATE DESCRIPTION IF LENGTHY): I
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• . . • .
TYPE OF PROJECT(This application): �BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM .
PRO]ECT DESCRIPTION (Provide detailed description): //L/"Lo«i-�d�-- p� aC� .ljoyt��
/���.. � O�f's-�c�' Ur.. 7'ft�'' .3 "'� �Gs•�. �4.-D Gb.�v�it,� `
1-.� %� �r-- o.Qctr- j� COo�r��.c- /l/un-.✓d- �I'T'�t�-�'a�--
PROJECT NAME:
• • • • •
PROPERTY OWNER' NAME: DArrtME PHONE: I
� lZ�t�c .r�c�,.- �.+�%�r .1'yJ i�,K c.2s.�> 9 Y�- 79�� i
, MAILuING ADDRESS(S7REET ADDRESS;CITY,STATE, IP):
� !.�1� � v +� --ra,ci�. �G�iO E�+.gC !v� �� ��v0 3
CONTRACTOR' NAME: DAYTIME PHONE:
sE�/cr',� Cp„�.rilt�c�ui,... (�G ) �05' - 7//7 �
MAILING ADDRE55(STREEf ADDRE55;CITY,STATE,ZIP): EVENING PHONE:
�- � Gt/C.t i C.��� �v� . .�. �K ��70 ( ) - I
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- - \ �
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / �
APPLICANT: NAME: j DAYTIME PHONE:p /
cJ � ���.r C../�I���/�i G I d r ���i� ���!� - 6 �`�
� MAILING ADDRE55(STREEf ADDRE ;CITY,STATE,ZIP): EVENING PHONE: I
l 7/7 S�. �. �/L6a'j f corr �--`l / �5`s T ( ) -
RELATIONSHIP TO PROJECT: �,[��� �^���G���N FAX NUMBER: ;
❑ ARCHITECT ❑ TENANT ❑ OTHER(DES�ftIBE): - (�,S,3)o7v 7 -��7r I
E-MAIL ADDRE55: �
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER �APPLICANT ❑ CONTRACTOR
. . . • • •
EXISTING USE:�7 d�/L!'.�f'L EXISTING BUILDING ASSESSED/APPRAISED VALUATION $J 7 /�I.tC«d�
PROPOSED USE: !-/ �o.I�.�l�t"C PROPOSED VALUATION FOR IMPROVEMENTS: $
`�b�.D6� o�
SPRINKLERED BUILDING? �YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES �NO
/
WATER SERVICE PROVIDER: �LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: E�LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• . . • •
FLOOR EXISTING S .FT. PROPOSED S .FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD � ��
�
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATNE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(5)
ggQ(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: ❑ ELECTRIC ❑ GAS
, � PLUMBING ���i� � �o�t.t���,,sh�-��''.
�Fi .i�.r�t.2+w ri�-`/A/!G`7� �..- f.�✓
BATHTUB(S) LAVATORY(S� URINAL(S) WATER 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)
� •
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 officers and employees,upon the accuracy
of the information supplied the city as a part of this application.
NAME/TITLE�� � /LG�IS� Co,�f//L- /'1,.�6/l• DATE: `S �°�y' � (
❑ PROPERTY OWN �AP CANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ A ITION ❑ ALTERATION ❑ REPAIR TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATI N : BUILDING SHELL ONLY? ❑ YES NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES � NO
SECTI TOWNSHIP RANG NEW ADDRESS REQUIRED? O YES NO
PLATTED LOT? ❑ YES NO CHANGE OF USE? ❑ YES NO
COMMUNITY DEVELOPMENT SER F1R5T WAY SOUTFi•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
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CityofFederalWay Building - Commercial Permit #:ol - 102230 - oo - CO
Community Deve(opment Secvices
33530]st Way S
Federal Way,WA 98003-6210,
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.g35.3�50
Project Name: ST FRANCIS HOSPITAL
Project Address: 34515 9TH AVE S Parcel Number: 750451 0020
Project Description: REMOD- Remodel area of 3rd floor to create nurses' station. *"No plumbing or mechanical on this
permit*"
Owner Applicant Contractor Lender
ST FRANC[S MEDICAL SELLEN CONSTRUCTION SELLEN CONSTRUCTION ST FRANCIS MEDICAL
1717 S J ST PO BOX 9970 SELLEC*372N0 6/1/02 1717 S J ST
TACOMA WA SEATTLE WA 98109 PO BOX 9970 TACOMA WA
98405-4933 SEATTLE WA 98109 98405-4933
Includes:
Census category: 437-Comm #1 #2 t�3 #4
Occupancy Group: I-1.1
Construction Type: Type I-FR
Occupancy Load:
Floor Area(Sq.Ft.): 160
lst Floor Proposed Sq.Feet.................................160 Building Pre-coa MeetingRequired...................No
Census Category.................................................437-Commercial alt/add Fire Sprinklers................................................. Yes
Mechanical................................................. No Number of Stories................................................3
Permit for Bui(ding Shell Only............................No Plumbing................................................. Yes
Special Inspection Required................................Yes Total Proposed Sq.Feet....:............::....................160
Will Certificate of Occupancy be Issued?............No Zoning Designation.............................................OP
PERMIT EXPIRES January 20,2002,IF NO WORK IS STARTED.
Permit issued on July 24,2001
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 ccordance with the laws,rules and regulations of the State of Washington and
the City of Federal Way.
/ �7 �� -
Owner or agent: Date: �
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' ' PO"�'r'HIS CARD ON THE FRONT OF BUILD""n •
� ��� BUIL�ING DIVISION
uV AY INSPECTION RECORD
INSPECTION REQUEST PHONE#: 253-835-3050
PERMIT #: 01-102230-00-CO
OWNER'S NAME: ST FRANCIS MEDICAL
SITE ADDRESS: 34515 9TH S
( ) FOOTINGS/SETBACKS ( ) FOUNDATION WALL
�.�= A ��� ��_:, . ��;.,�=DO,NOT�O'�TR�ONCRETE�[,TNTiL�;�HE A:BQ��TS"�'�P�tO'YED „��i .
( ) DRAINAGE: Line ( ) Connection
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( ) UNDERFLOOR FRAMING
( ) ROUGH PLUMBING: DWV Water piping
( ) ROUGH MECHANICAL Gas piping
( ) SHEATHING Roof Floor.
( ) SHEAR WALLS
( ) ELECTRICAL ROUGH-IN Ditch Cover
( ) FIRE/DRAFTSTOPS
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( ) FRAMING/FIRESTOPPING — 7 " �/ G
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( ) INSULATION: Floors Walls Attic
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( ) WALLBOARD NAILING ( ) SUSPENDED CEILING
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( ) ELECTRICAL FINAL �l ' L Q�" d / ,�
( ) PLANNING FINAL
( ) PUBLIC WORKS FINAL
( ) FIRE FINAL
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( ) BUILDING FINAL � ^' 2 �� �. O � C l�r/ _
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