13-105420 '' aectricah .
City of Fe way
Community&Econ. Permit #: 13-105420-00-EL
Econ.D ev.Services
33325 8th Ave S " 9
Federal Way,WA 98003 ) L._
Ph:(253)835-2807 Fax:(253)835-2609 `[ r Inspection Request Line: (253)835-3050
Project Name: KOHL'S AT THE COMMONS
Project Address: 2101 S COMMONS Parcel Number: 762240 0010
Project Description: Installation of 40 Cat 6 communication lines for video cameras.
Owner Applicant Contractor
KOHL'S DEPARTMENT STORE CRANE CREEK HOLDINGS LLC CRANE CREEK HOLDINGS LLC
N56 W17000 RIDGEWOOD DR 12556 120TH AVE NE UNIT 322 CRANECH909P7(10/27/14)
MENOMENEE FALLS WI KIRKLAND WA 98034 12556 120TH AVE NE UNIT 322
53051 KIRKLAND WA 98034
Additional Permit Information
Is this an Online or O.T.C.application? Yes Is Use Educational or Institutional? No
Service greater than 999 Amps? No
Electrical Fixtures
Low Voltage-Other(Commercial 1
PERMIT EXPIRES Tuesday, June 3, 2014
Permit Issued on Thursday, December 5, 2013
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: /� e5/
FINALED
THIS CARD IS T MAIN ON-SITE
1 OF 41&111116'f CITY ' • Construction In ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 13-105420-00-EL Address: 2101 S COMMONS
Project: KOHL'S DEPARTMENT STORE FEDERAL WAY, WA 98003
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as
possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your
inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
o UFER Ground(4295) '0 Ditch cover(4030) - 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
El Pool Bonding(4195) 0 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
Feeders/Sub-panels(4045) 0 Rough Electrical(4225) ❑ Ceiling Cover(4020)
o
.
Approved PP Approved Approved
By Date By Date y C S Date I a- L_ ! 3
o Final-Electrical(4055)
Approved
4 Date t-2(- ( 1.7)
I
El Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED
DEC 0 5 13 _ / Q -S'y,z_o
CITY OP
Federal w ' OF FcEas'E ;ECTRICAL
PERMIT APPLICATION
**Most electrical ermits ma be obtained on-line at www.ci o'ederalwa .com**
SITE ADDRESS: 0 S
,3 - 0 .�� Sfi-6rr2-
PROJECT NAME 4 V l 11.1)'1 G Arct lel STo ((Q. Or)
(Tenant or Homeowner Last Name)
E)-$ z-1.0 Qrt o Co
PROJECT DESCRIPTION n a>p1 GUat f rA: O■1 I Yt .S L.(
Detailed description of work to lid
be included on this permit only Cf„LrY`p VO>
NAME PRIMARY PHONE
PROPERTY OWNER f -L _cd-Co,� 4 cifjo1 on 0,713 t (�LC', (3)83ci- (�(s-
MAILING ADDRESS E-MAIL
ictQg 9, C'Ay vYY Ov3s CVeeaC +eLo 'i
CITY STATE ZIP FAIL
` , ,� GOcce3 9 f3-C)013 c7c�3) 11-1(9- 1'4/3
PRIMARY PHONE
Hz td.(vac (_Le, (l4 ) q- ao-x_)
MAILING ADDRESS E- •
ELECTRICAL 13. -S--4, I a U+h N E. 001)i.on be o)c c'h ct)/cd1 LMT .
CONTRACTOR c STATE ZIP LJ FAa
h orlk is not 9 3L/ (f o fp9 - cgica
WA STATE CONTRACTOR'S LICENSE it EEPIRATION DATE FEDERAL WAY BUSINESS LICENSE
C ,E_Ig-N_C f( TEfl i6101((
NAe� �y PRIMARY PHONE
APPLICANT Cx�u CX2 k2)lA[ c7 (1( _ ("I )SLo q- 020(.)
MAILING ADDRESS E-MAIL
(a5SZQ la(*. Ie (�� 2 (�1uy�1 ao cc hsa I�tlons.
,C� STATE ZIP FAX
47-K\(1 03A ,"7-?Li ('fa ) -QL/(
PROJECT CONTACT ! t n t-.„ J `��� � ( ) -PHONE
'f
I certify under penalty of perjury that I am the property owner or authorised 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 Jbr 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 fled 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: : . . I � � DATE la 1/-1 ( 1 73
PRINT NAME e
33325 8*Avenue South•Federal Way•WA•98003-6325•253-835-2607•tae:253-835-2609•www.cityoffederalway.com
Bulletin#160-January 1,2011 Page 1 of 2 k:Wandouts\Electrical Permit Application