02-105368 �;tY,,�Federal Way Building - Commercial Permit #:02 - 105368 - Ofi�- C(;�
Community Decelopment Sen�ices
33530 ist Way S
Federal Way,WA 98003-6210
P>>:zs3.66�.a000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: ST_FRANCIS MOB SLEEP LAB
Project Address: 34509 9TH S Parcel Number: 750451 0010
Project Description: TI-TI for a 4 suite 2977 square foot sleep lab located on the first floor of the existing ST Francis MOB.
Include plumbing and mechanical.
Owner Applicant Contractor L.ender
Sl'FKANCIS MED CTR ASSOC NONE RUSHFORTH CONST CO INC ST FRANCIS MED CTR ASSOC
1717 S.(ST RUSHFC*305R1 3/15/03 1717 S J ST
TACOMA WA 98405-4933 6021 12TH ST E SUITE 100 TACOMA WA 93405-4933
NONE TACOMA VVA 98424
lnchides:
Census category: 437-Comm �1 #2 #3 #4
Occupancy Group: B
Construction Type: Type II-FR
Occupancy Load: 30
Floor Area(Sq.Ft.)--� 2977 _,i �
lst Ploor Nro��otie�Sq.E�eet.................................2977 E3uilding Pre-con.Meeting Required...................I�...
.,�
Census Cate�;�ry................................................437-Commercial ali/add Fire Sprinklers................................................. Yes
Mechanical................................................. Yes Nuinber of Stories................................................]
Permit tbr E3ui!d;��,Sh�ll Only...........................Yes Plumbing....................._.._...................._ Yes
Spccial Inspectiun Required................................No Will Certificate of Occupancy be Issued"............Ye�
lonin�Designa:ion.............................................OP
Plumbing Fixtures
�__ Description _ _ j[Quantity � Description _ ��Qu y� Description _—�iQ ntity
,
C--- — -- -------J � � Showers ---- --— _ — 1 i Water Closets ------- i 3
Lavatoncs I----�� ��L—
Sin]<s---- — --- 1�
—J
Mechanical Fixtures
__Description Quantity ; Description Quantity � Description J�C��.2uantit
--- -----
i D,��s--------- ���
CONDITIONS:
All new and refaced signs require a separate sign application and review.(FWCC,Sec.22-335(g)(6))
PERMIT EXPIRES July 26,2003,IF NO WORK IS STARTED.
Permit issued on January 27,2003
1 hereby certify that the above infomiation is correct and that the construction on the above described property and
the occupancy and the us�will be in accordance with the laws,rules and regulations of the State of Washington and
the City of Federal Way. /?
Owner or agent:_ �� � �� Date: /—��� G---��
�
�, Cit�,z..�f Federal Way . ,
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Se�tion 109 of the Uniform Building Code certifying that at
the time of issuance,this structure was in compliance with the various ordinances of the City regulating building
construction or use. This certificate is valid ONLY when endorsed by Citv staff.
Tenant Name: ST FRANCIS MOB SLEEP LAB Permit number: 02- 105368-00
Address: 34509 9TH S
#1 #2 #3 #4
Occupancy Group: B
Cons[ruction Type: Type II-FR
Occupancy Load: 30
Floor Area(Sq.Ft.): 2977
Owner ST FRANCIS MED CTR ASSOC
Name: 1717 S J ST
Address: TACOMA WA 98405-4933
�MK• �'ka,.li+1, C dC� !� - !: - o�c...��
Building Official Date
The priorin�jocus in�he reriew nnd inspectiom m�de by the City prior to issamnce of this Certificate was on those mntlers whrch zrperie,vice hns shown most severely
nffect the hea/th nnd safery ofYhe genernl public. Although the City hns made as complete a review arrd inspec�ion ns is reasonably possible(ivifhin budgeinry time
• nnd personnel limitntrons),Ihe City neither gum'anfees nor warrr.nts to Che owner/occupand or to nny olher person 7hn!this Cerh'firnte evrdences strict comp(innce
with eneh and every ordinrmce or regulation ojthe City or the Stnte ojWnshing�or�nffectin�the constn�rtinn ar use ofsnid structure or the lnnd upon xfirch it is
sihialed. Sucl�romp/iance is[he responsibility of the owner nnd/or occupnnt of the premises.
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PO H1S C�RD ON TEE�RONT'C�t+BUILI3 '
� ���L �UIL�II�TG DIVI�ION
.
uV FiY �I�ISPECTION RECORI!
' �NSPEC'd'ION p2EQIJEST PIiQN�#: 253-835-3050
PERMIT #: �2-105368-00-CO
OWNER'S NAME: 5T FRANCIS MED C'TR ASSOC
SITE ADDRESS: 34509 9TH S
( ) FOOTINGS/SETBACKS _ ( ) FOUNDATION WALL__
` ' ,�xDO NOT�POUR CONCRETE LTIY'TIL THE ABOVE IS APPRO�ED���' �'
,�� �� ,�� ��F�,k:--
( ) DRAINAGE: Line ( ) Connection
^;�- � ` �°� #` ����.; O� OT PUUR SLAB IJNTIL THE ABOVE�IS ���PROVED � �-�� ��" �`
���� �.,,����„ _. ti.�.�.��w��_�.�.. ,�� �`.
, ' ` ��u'wt`�.
O UNDERFLOOR 1�'i 3 �S- �3 �
O ROUGH PLUMBING: DWV Water piping
( ) ROUGH MECHANICAL_ (s� " Z..- c� � �J Gas piping _
( ) SHEATHING Roof _Fioar _
( ) SHEAR WALLS
( ) ELECTRICAL ROUGH-IN Ditch Cover __
( ) FIRE/DIUIFTSTOPS
.�,n- �
': -. ALI.�.;CHE�'ABOVE���iVIUST BE APPROVED PRIO TO FRAMING 1NSPECTION k-��-��_ s :�..,n, 4 -;`=
( ) FRAMING/FIRESTOPPING - -�O __ ___ __
THE ABOVE MUST BE APPROVED PRIOR TO INSULATING OR SHEETROCHIPTG q;` _ ;
�. . ��._�w: ,. _
( ) INSULATION: Floors Walls_ Attic
� '� THE ABO�'E�;11'7UST�BE��APPROVED PRIOR TO�APPLYING SHEETROGK �e � `�� ���� �
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, .,,.- . � �,a�
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..� , � �x���_. . :�
O WALLBOARD NAILING�� � p 3�C. �O SUSPENDED CEILING ,. Z - c� 3 GC� �
`„��,��� ,` -. THE ABOVE MU�.T„BI�'.��A��PROVED PRIQRfiO TAPING OIiINSTALLING:CEILTIV'G��n� . _�,��,� . -<
O ELECTRICAL FINAL (p - Cs - � 3 F(� _.
( ) PLANNING FINAL
( ) PUBLIC WORKS FINAL
( ) FIRE FINAL (� � S- n 3 GG�
���,�. :.,�.,THE��O„'V�,E�Mi�S w PROV�D�RIOR TO BiIILDING�DEPAR Y��
�, .� ..��_ �._� ,., � �..� . . _ �
( ) BUILDING FINAL (9 -- � -G9�� c„�)
�``'DO.NOT OCCUP�THIS BUILDING;UNTIL BUILDING FINAL: S'�pPROVED� �
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" ' INSPECTION LOG �
DATE INSPECTOR OK CORR/REJ AREA AND TYPE OF INSPECTION
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' ��•G CONSTRUCTION PERMIT APPLICATION
� ���L- `�-�'����� PPLICATION NUMBER: ,Q�--' QS� � ' �
�� n �^r. PPLICATION NUMBER: _ _ - -
PPLICATION NUMBER: - -
**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.
. � . . . .
SITE ADDRESS: �O� �� /�� �- ASSESSOR'S TAX/PARCEL#: / S� � '�71 - � (/��
LEGAL DESCRIP7TON OF SUB]ECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): :�����
• • • • •
TYPE OF PROJECT(This appiiwtion): �UILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING o FIRE PREVENTION SYSTEM
PRO7ECT DESCRIPTION(Provide detailed description): � � �J� .S^ /.
2 � b � D.-,
�Li�i 9fas7�i�o��� i,.�c�s !� D„g
PROJECT NAME: �S � v/ / /��NGIS ///�� S(,�i�
• • • • •
PROPERTY OWNER: NAME: DAYiIME PHONE:
�YG�h c�.h � s (�.3)5� -
MAIL NG ADORESS(ST�REET ADDRE55;CITY,S7 ,ZIP):
��� .�l� 5 AC�J/J'��I' S
CONTRACTOR: N�E� � �� � DAYTIME PHONE:
n, ������ �. �i'�� '�� �.�1N ( ) -
\\7( , MAILING ADORESS(SfF2EEi ADDRESS;CIIY,SfATE,ZIP): EVENING PHONE: _
/ \��� CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: � y/� �AX NUM�R:
c..c� - - � ) -
CONTRACiOR'S REG15fRATION NUMBER: EXPIRATION DATE:
� �
APPLICANT: NAME' DAYTIME PHONE:
�r�J/ h�h�i✓ av� �20 )�3 OZ
�Il NG A�RESS(�E�RESS;CITY,ST�%ZIP):/� � � � EVENING PHONE�� _D�
L/ .� T 1
�-
REL�A NSHIP TO PROJECT: F�ll(NUMBER:
�ARCHITECT ❑TENANT ❑ OTHER(DESCRIBE): Q� � -�!�
E�Ao�IIfc�P�X o�ai
CONTACT PERSON FOR THIS PRO7ECT: ❑ PROPERTY OWNER ❑APPLICANT ❑CONTRACTOR
�
� . . • • •
EXISTING USE: /��L�"F/'�3%t EXISTING BUILDING ASSESSED/APPRAISED VAWATION ¢�//� UD• l�//
PROPOSED USE: ///C-!il/C� PROPOSED VALUATION FOR IMPROVEMENTS: $ "!�� O�_
SPRINKLERED BUILDING? �1'ES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:tr'YES ❑ NO
e
WATER SERVICE PROVIDER: �CAKEHAVEN ❑ HIGHLINE ❑TACOMA o PRIVATE(WELI)
SEWER SERVICE PROVIDER: �C.AKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTiAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: �
• . • • •
FLOOR EXISTING .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(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACEINSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GA IPE OU LET S)\ ^ HEAT SOURCE: ❑ ELECTRIC o GAS
� � ���� l.
UMBING
BATHTUB LAVA ORY(S) URINAL(S) WATER HEATER(S)
DISHWASHE RAIN WATER SYS. VACUUM BREAKER(5) ❑ ELECTRIC ❑GAS
DRINIQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(5) SUM P(S)
r •
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 nold 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 here such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information su plied to the city as a part of this application.
NAME/TITLE !/I 7�I� DATE: f / !i /. D!�
❑ PROPERTY O NER PPLICANT ❑CONTRACTOR