11-105061APPD D
CITY OF Federal Way ' + PER
C 253 - 83607` FAX 253- 835- 2609E8 �c �° A'++ ,,•I CATI O N
uwu.cifvof(ederahz�rzu.cnrn � �• -�y
I
-9L-iQ-5 0 & �
n EM D ME PL DE EN
DEC 21 2011
^T* I � rrnr!nAf %AIAW
SITE ADDRESS
CDS
E /UNIT #
625 South 314th Street
�o" r tabl e Classro
PROJECT VALUATION
ZONING
ASSESSOR'S TAX /PARCEL #
$ 17,587.00
RS7.2
0 8 2 1 0 4- 9 0 3 5
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING Ck FIRE PREVENTION
NAME OF PROJECT
jrenantName/HOmeownerLastName)
Mirror Lake Elementary Portable Classroom Addition
PROJECT DESCRIPTION
Detailed description of work to
Pull new IDNET & signal circuit to portable for new
devices 2 pull stations • 2 smoke detectors • 4 heat
be included onthis permit only
detectors w/2 IAMS 1 waterproof horn /strobe
NAME
PRIMARY PHONE
PROPERTY OWNER
Federal Way Public Schools
253- 945 -2000
MAILING ADDRESS
E-MAU,
31405 18th Ave S.
CITY
STATE
ZIP
Federal Way
WA
98003
NAME Scott's Electric Service
20Ng- 898 -6308
MAILING ADDRESS
E -MAD,
CONTRACTOR
23811 S R 2
CITY Monroe
BWA g
z� 98272
FAX
360- 805 -4634
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
SCOTTES969RA
02/20 /13
NAME
SimplexGrinnell
PHONE
206- 291 -1400
APPLICANT
MAILING ADDRESS
E-MAIL
9520 10th Ave S Suite 100 'astebbi
s @sim lex rinnell
CITY
STATE
ZIP
FAS
Seattle
WA I
98108
206 - 291 -1500
PROJECT CONTACT
NAME
PHONE
Janet Stebbins/SimplexGrinnell
206- 291 -1468
(The individual to receive and
MAILING ADDRESS
9520 10th Ave. S. Suite 100 jastebbi
E-MAU,
s @simplexgrinnell.
respond to all correspondence
concerning thtsapplication)
CITY
STATE
ZIP
FAX
Seattle
WA
98108
206 - 291 -1500
ALTERNATE CONTACT NAME:
PHONE
E-MAIL E -MA
John Solbakken
206 - 291 -1424
PROJECT FINANCING
NAME
OWNER - FINANCED
Required value of $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.
SIGNATURE(% %� ►'�1C DATE 12/20/11
PRINTNAME: Janet Stebbins for SimplexGrinnell
Bulletin #100 — January 1, 2011 Page 1 of 3 k:\Handouts\Perniit Application
)m
com
$031 —t1