The planning group is proposing several upgrades, including a $952 million hospital tower, a $79 millon behavioral health center and $178 million in renovations and other improvements.
Harborview Medical Center is owned by King County and operated by the University of Washington, also based in Seattle.
County officials created the Harborview Capital Planning Leadership Group in 2018 to study the scope of improvements that would be needed. Group members are county, hospital and union leaders.
King County Executive Dow Constantine wants to fund the upgrades with a bond measure.
He is aiming to place the bond measure up for vote on a ballot later this year.
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