20-104486CITY OF
Federal Way
RECEIVED PERMIT APPLICATION
Nov 20 2020 PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER 2 0 1 0 4 4 8 6 _
TARGET DATE
SITE ADDRESS
34512 South 16th Ave, Suite A, Federal Way, WA 98003
PROJECT VALUATION
$ 385,739
TYPE OF PERMIT
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
SUITE/UNIT #
A
ZONING ASSESSOR'S TAX/PARCEL #
CE 2 5 0 0 9 0 0 0 5 0
N BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
MultiCare Health Systems Tenant Improvement
All spaces are type B occu anc aroup, medical office building/
The project includes the design and build -out of clinical space for
a Family Medicine clinic.
NAME Fedway Marketplace West, LLC
PROPERTY OWNER BLAMING ADDRESS
C/O M ] Klein, CPA, 30300 Agoura Road, Suite 270
CITY STATE z"'91301
Agoura Hills CA
—
NAMETBD(To Be Determined)
MAH.ING ADDRESS
CONTRACTOR
CITY STATE ZIP
PRIMARY PHONE
310-629-0466
E-MAIL
jlo55@aol.com
PHONE- ..
E-MAM
FAX
UBI #
PRIMARY PHONE
(206)601-6645
E-MAIL
KLanglois@I nsightDesignStudio.biz
FAX
PRIMARY PHONE
(206)601-6645
E-MAIL
KLanglois@I nsightDesignStudio. biz
FAX
® OWNER -FINANCED
PHONE
I certify under ponoIty of perjury that I am the property owner or authorized agent of the property owner. I cerft that to the hest
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 fincluding costs, expenses, and attorneys' fees incurred in
eke 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.
��Vt,Si 11/9/2020
SIGNATURE: I HATE
axo s?ZWF
PRINT NAME: le rey Oliphant, President. Fedway Marketplace West, LLC
Bulletin #100 -February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
WA STATE CONTRACTOR'S LICENSE M
EXPIRATION DATE
NAME
Karsea Langlois, Insight Healthcare Architecture
MAD.ING ADDRESS
12345 Lake City Wa
NE #2108
APPLICANT
CITY Seattle
1
STATE
WA ZIP 98125
PROJECT CONTACT
NAME
Karsea Langlois, Insight Healthcare Architecture
MAILING ADDRESS
12345 Lake Ci Way
NE #2108
(The individual to receive and
respond to all correspondence
WAE 798125
concerning this application)°ITYSeattle
NAME
PROJECT FINANCING
N/A
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
(RCW 19.27.095)
PRIMARY PHONE
310-629-0466
E-MAIL
jlo55@aol.com
PHONE- ..
E-MAM
FAX
UBI #
PRIMARY PHONE
(206)601-6645
E-MAIL
KLanglois@I nsightDesignStudio.biz
FAX
PRIMARY PHONE
(206)601-6645
E-MAIL
KLanglois@I nsightDesignStudio. biz
FAX
® OWNER -FINANCED
PHONE
I certify under ponoIty of perjury that I am the property owner or authorized agent of the property owner. I cerft that to the hest
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 fincluding costs, expenses, and attorneys' fees incurred in
eke 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.
��Vt,Si 11/9/2020
SIGNATURE: I HATE
axo s?ZWF
PRINT NAME: le rey Oliphant, President. Fedway Marketplace West, LLC
Bulletin #100 -February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $ 289,652
Indicate how mang of each 4Lve offixture to be installed or relocated as pan of this 12roject. Do not include exis tq ratures to remain.
AIR HANDLING UNITS 1 FANS GAS PIPE OUTLETS OTHER (Describe)
3 AIR CONDITIONER FIREPLACE INSERTS HOODS commeroiaq
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
1 DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK 1
PLUMBING PERMIT $ 169,744
Indicate how manof each type offixture
to be installed or relocated as
part of this prooct. Do not include existing
res to aremairL
BATHTUBS (or Tub/showercombo)
18 LAVS (Hand Sinks)
b TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS 1
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
Electric WSter
DRINKING FOUNTAINS
3 SINKS (wiohen/utility)
WATER HEATERS (Electric)
Heater
HOSE BIBBS
SUMPS
WASHING MACHINES 27
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
# of
Stories
COVERED ENTRY
NEW BUILDING
EXISTINGIPREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
B
41,323
X Yes ❑ No
❑ 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
Area in
Square Feet
Occupancy Group(s)
X
# of
Stories
COVERED ENTRY
NEW BUILDING
DECK
ADDITION
GARAGE ❑ CARPORT ❑
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
OTHER (describe)
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
Area Totals
EXISTING
PROPOSED
TOTAL
�r��r �y/���y�� ■r��y
- •»l�f:/YY ,4V112E$ OAILl *
TENANT AREA ONLY
ESTIMATED SELLING PRICE $ # OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
TOTAL BumDENG
TENANT AREA ONLY
PROJECr AREA ONLY
a
Bulletin #100 — February 19, 2020 Page 2 of 2 k:\IIandouts\Permit Application