21-102382-Building Permit Application-06-10-2021-V1pdf41k
CITY OF ��
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
27320 Pacific Highway South, Federal Way, WA 98003
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ 30,200.00
TYPE OF PERMIT
e BUILDING A PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
DaVita Redondo Heights Dialysis
Add one new treatment station to existing patient treatment floor, casework and a counter top, move a water line,
PROJECT DESCRIPTION
add four electrical outlets
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
Tenant: DaVita, Inc.
253-606-6191
PROPERTY OWNER
MAILING ADDRESS
*Atli,
rIS in.videto@davita.com
32275 32nd Ave. S.
CITY
STATE
ZIP
Federal Way I
WA 198001
NAME
Axiom Northwest Construction
PHONE
425-903-4038
MAILING ADDRESS
2232 Broadway, Ste. 101
AIL
I Julia@axiomnw.com
CONTRACTOR
CITY
STATE
ZIP
FAX
Everett
WA
98201
WA STATE CONTRACTOR'S LICENSE #
AXIOMNC920LJ
EXPIRATION DATE
07 i28 /22
UBI #
602 838 426
NAME
James Buchanan
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
2232 Broadway, Ste 101
E-MAIL
james@axiomnw.com
CITY
STATE
ZIP
FAX
Everett
WA
98201
NAME
PRIMARY PHONE
PROJECT CONTACT
Julia Robinson
615-943-5042
MAILING ADDRESS
2232 Broadway, Ste. 101
E-MAIL
Julia@axiomnw.com
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
Everett
WA
98201
PROJECT FINANCING
NAME
❑E OWNER -FINANCED
When ualue is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
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,
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.
,8 DATE June 10, 2021
SIGNATURE:
PRINT NAME: James Buchanan
Bulletin #100 —February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how mang of each ty
pe of fLxture to be installed or relocated as part of this projecL Do not include existikq frxtures to remah
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (Commenciaq
BOILERS FURNACES HOT WATER TANKS (aasi
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING PERMIT Is
Indicate how mang of each ttjpe of fixture to be installed or relocated as part of this project. Do not include existiaufLxtures to remain.
BATHTUBS (a,-rub/Shower Combo) LAVS (Had Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS (Kitche„/Utility) WATER HEATERS (eiecc,ic)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Yes n No
n Yes x No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
- -
_...._....... ...... .. ................... ........ ..._
Area Totals
EXISTING
PROPOSED
TOTAL
**NEW HOMES ONLY"ESTIMATED
SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Groups)
Construction
lype
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
r
TENANT AREA ONLY
6,500
B
PROJECT AREA ONLY
120
1
1
1 Minor Alteration
Bulletin #100 - February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application
FAeral Way 100 Permit Application
udit Report 2021-06-10
Created: 2021-06-10
By: Julia Robinson (Julia@axiomnw.com)
Status: Signed
Transaction ID: CBJCHBCAABAAHWsllkpSNluiowzebMe73aknQCTUO8sV
"federal Way 100 Permit Application" History
f) Document created by Julia Robinson (Julia@axiomnw.com)
2021-06-10 - 11:33:32 PM GMT- IP address: 68.52.137.229
Document emailed to james buchanan (fames@axiomnw.com) for signature
2021-06-10 - 11:34:08 PM GMT
Email viewed by james buchanan (fames@axiomnw.com)
2021-06-10 - 11:48:57 PM GMT- IP address: 24.17.238.183
bQ Document e-signed by james buchanan (fames@axiomnw.com)
Signature Date: 2021-06-10 - 11:50:14 PM GMT - Time Source: server- IP address: 24.17.238.183
�j Agreement completed.
2021-06-10 - 11:50:14 PM GMT
l
Adobe Sign