16-102055At
City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax (253) 835-2609
Project Name: T -MOBILE- SE04653A LAKOTA PARK
Project Address: 31334 SW DASH POINT RD
Building - Commercial
Permit #:16 -102055 -00 -CO
Inspection Request Line: (253) 835-3050
Parcel Number: 122103 9016
Project Description: ALT - Replacement of existing light pole, removal of (3) panel antennas, addition of (3) new
panel antennas, removal of (6) TMAs, addition of (1) COUP surge protector, addition of (8)
RRUs and cabling and (12) diplexers.
Owner
Applicant
Contractor
Lender
CITY OF FEDERAL WAY - PARKS
COLIN ROBINSONCENTERLINE
S A C WIRELESS LLC
33325 8TH AVE S
SOLUTIONS
540 W MADISON AVE FLOOR 16
FEDERAL WAY WA 98003
8210 154TH AVE NE
CHICAGO IL 60661
REDMOND WA 98052
Census Category: 437 - Commercial alt / add / conversion
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area (sq. ft.) 1 0.00 0.00 0.00 0.00
Additional Permit Information
Mechanical to be Included? ..................................... No Number of Stories..................... ......................... I
Is this an Online or O.T.C. application? .................. No
Plumbing to be Included? ........................................ `No
Total Valuation: 50,000.00
Permit for Building Shell Only? .............................. No
New / Additional Sq. Feet - Total ...........................
PERMIT EXPIRES Saturday, 15 April, 2017
Permit Issued on Monday, October 17, 2016
I hereby certify that the above information is correct and that the construction on the above described property
and the occupanc d 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: L
MY os 14A•
Federal Way
PERMIT #: 16102055 00
Project: T -MOBILE
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
Address: 31334 SW DASH POINT RD
FEDERAL WAY WA 98023
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.
®
Initial Erosion Control (4365)
El
Footings/Setback (4110)
Q
Foundation Wall (4115)
Right of Way
To be done PRIOR to breaking ground
lBy
Approved to place concrete
Approved to place concrete
By
Date
By
Date
By
Date
®
Drainage/Downspout (4040)
El
Re -steel (4215)
®
Slab/Concrete Floor (4255)
Right of Way
Approved to backfill
Approved to place concrete or grout
Approved to place concrete
By
Date
By
Date
By
Date
®
Underfloor Framing (4285)
®
Floor Sheathing (4105)
®
Shear Walls (4245)
Right of Way
Approved to sheath floor
Approved to install flooring
Approved to install siding
By
Date
By
Date
By
Date
10
Roof Sheathing (4220)
18
Fire/Draft Stops (4095)
Q
Interim Erosion Control (4370)
Right of Way
Approved to install roofing
Approved
Approved
By
Date
By
Date
By
Date
Prior to scheduling a Framing inspection; 13 Framing (4120) 14 Insulation (4150)
Electrical, Plumbing & Mechanical Rough -in Approved to insulate Approved to install wallboard
and Fir&Draft Stop inspections must be signed -
off and approved. IBC 1093.4 By Date By Date
15
Gypsum Wallboard Nailing (4130)
18
Suspended Ceiling Grid (4265)
®
Final - S K F & R (4060)
Right of Way
Approved to install mud & tape
Approved to drop tile
Approved
By
Date
By
Date
By
Date
�$
Final - Planning
®
Final - Public Works (4080)
®
Final Erosion Control (4375)
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
® Final - Building (4050)
Approved
By Date I ..
Right of Way
Final Electrical
Rough Electrical
Approved
Approved
Approved
By
Date
By
Date
By
Date
SE04653A Lakota Park 0
CITY OFNDIVED PERMIT APPLICATION
federal Way PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
APR 2 8 2016 253-835-2607 + FAX 253-835-2609 + pern-titcente cucitvoffederalway.com
PERMIT NUMBER
1 �O _ I C V �F FLAY C, (�
- TARGET DATE
SITE ADDRESS
SUITE/UNIT N
31250 SW DASH POINT RD Federal Way, WA 98023
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL i
$ 50,000
RS15
1221039016 _
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
SE04653A - Lakota Park L700
o i ication o existing wireless comions facility on light muni po e. cope
PROJECT DESCRIPTION
Detailed description of work to
replace9 light ole, remove 3 panel antennas, add 3 new panel antennas,
p
be included on this permit only
remove 6 TMAs, add 1 COVP, add 8 RRUs with cabling, and add 12 diplex
On ground: decomission 1 UMTS 2100, add 1 COVP and remove 6 diplexe
NAME City of Federal Way
(253) 835 - 6962
PROPERTY OWNER
MAILING ADDRESS 33325 8th Ave Southl
MAI
ason.Gerwen@cityoffe
CITY Federal Way
SWA I
ZIP 98003
NAME TBD
PHONE
MAILING ADDRESS
EMAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE /
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE t
N"mEColin Robinson for T -Mobile
F2M�R_�665
APPLICANTNAIL
IA�18154 h Ave NE crobins
n a centerlinesolutions.c
c'Redmond
�z'�8052
FAX
NAME Colin Robinson
P !M--2665
PROJECT CONTACT
mAm NGADDRESS 8218 154th Ave NE Suite 120 crobin
n a�centerlinesolutions.
(The individual to receive and
respond to all correspondence
CITY Redmond
W')k
ZIP 98052
FAX
concerning this application)
PROJECT FINANCING
RAMS N/A
1�f OWNER -FINANCED
When value is $'5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert(%y 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 authorised 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 jUrther 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 clainq, 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 o lcers and employees, upon the accuracy of the
information supplied to the city as a part off this application.
%
SIGNATURE: ` `'/ r� �2 1J� DATE 2 y ` 6
PRINT NAME: Colin Robinson for T -Mobile
Bulletin #100 — January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application
-S
I
eral
)m
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how magy of each type offixture to be installed or relocated as part of this project. Do not include existingfixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commerciap
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
No
N/A
N/A
20,000
$
Indicate how many of each type offixture
to be installed or relocated as
part of this project. Do not include existing tures to remain.
BATHTUBS (or Tub/Sho— Combo)
LAVS (Hand Sinks(
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DECK
DRINKING FOUNTAINS
SINKS (Kitchen/utility
WATER HEATERS (Electric(
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
No
N/A
N/A
20,000
FIRST FLOOR (or Mobile Home)
$
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SP�RI'�'ER SYSTEM?
PROPOSED FIRE SUPPRES ON SYSTEM?
ball field / wireless facility
❑ Yeses No
❑ Yes �No
RESIDENTIAL -NEW OR ADDITION '
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
NEW BUILDING
FIRST FLOOR (or Mobile Home)
ADDITION
SECOND FLOOR
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
COVERED ENTRY
Occupancy Group(s)
Construction
# of
Stories
Additional Information
DECK
GARAGE ❑ CARPORT ❑
TENANT AREA ONLY
OTHER (describe)
PROJECT AREA ONLY
Area Totals
EXISTING
PROPOSED
TOTAL.
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE $
I # OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Ar68 in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 - January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application