01-103302City of Federal Way
Commwiity Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129
Project Name: ST FRANCIS HOSPITAL
Project Address: 34515 9TH 1 A\J Z 5
Plumbing Permit #:01-103302 - 00 - PL
Project Description: PLUMBING - Install (1) sink on 3rd floor.
Inspection request line: 253.835.3050
Parcel Number: 750451 0020
Owner
Applicant
Contractor
ST FRANCIS MEDICAL
UNIVERSITY MECH CONTRACTORS
UNIVERSITY MECH CONTRACTORS
1717 S J ST
1300 N 130TH
1300 N 130TH
TACOMA WA
PO BOX 33723
PO BOX 33723
98405-4933
SEATTLE WA 98133
1 (206) 364-9900
Plumbing Fixtures
Description _�QuantRy Description Gluanti Description IlQuantity
Lavatories
PERMIT EXPIRES February 17, 2002, IF NO WORK IS STARTED.
Permit issued on August 21, 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 accordance with the laws, rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: Date: /O
6. ep lG 2- 04
_yOf R EC E CONSTRUCTION PERMIT APPLICATION
F�EIZRL— PPLICATION NUMBER:
uv F3Y APPLICATION NUMBER: _ _ _ _ _
APPLICATION NUMBER:
]VC "The fol[oi�iirig`-���fequie-c�'d information -Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY WOMATION
SITE ADDRESS: 16/ 15- 9 -All &9-_4e�vYL ASSESSOR'S TAX/PARCEL #: q
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): �L r �. w r�
PROJECT NAME:
PEOPLE■
PROPERTY OWNER: NAME:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
CONTRACTOR:
DAYTIME PHONE:
NAME: i
DAYTIME PHONE:
LA Eli t`1�
7-C."43/IC.A
(20(,)3&Li (?�
MAILING ADDRESS (STREET
1300 .
ADDRESS; CITY, STATE, ZIP):
1.30`4" Stfb-TrLf—
WA. T9 3-701
EVENING PHONE: -
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
_IO_
60,(6L)
�p
-
CONTRACTOWS REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card required)
1
U •1.
, �1
y
C—
A ' a y 3- N 1
APPLICANT:
NAME: ,
0 23t•L. J7Z S. CA VIA-,,, �. c�
DAYTIME PHONE:
(2061 ) 3
6117 �
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
RELATIONSHIP TO PROJECT: p FAX NVMBER-
❑ ARCHITECT ❑ TENANT ❑ OTHER (DESCRIBE); No(; ).3c s- -
3�9
E-MAIL ADDRESS' '
CONTACT PERSON FOR THIS PROJECT: ElAPPLICANT PROPERTY OWNER ❑ CONTRACTOR
iDIETAILEDBUIL a f •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $_.
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED. ❑ YES
❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN Cl HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS:
FLOOR
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
ESTIMATED SELLING PRICE:
EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
_
BBQ(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:
El ELECTRIC El GAS
PLUMBING
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
)
r GAS PIPE OUTLET(S)
SINKS)
WATER CLOSET(S)
— MISC. (_
INTERCEPTOR(S)
SUMP(S)
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 officers and employees, upon the accuracy
of the information supplied to the city as a part of this application.
DATE: 2
NAME/TITLE: ,��
ElL'1 PROPERTY OWNER APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION
CENSUS CODE:
ZONING DESIGNATION:
COMP PLAN DESIGNATION
SECTION TOWNSHIP RANGE
PLATTED LOT? ❑ YES 0 NO
❑ REPAIR ❑ TENANTIMPROVEMENT
LOT SIZE:
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN? ❑ YES ❑ NO
NEW ADDRESS RE UIR>ri]? ❑YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO