16-103002 Electrical
City of Federal Way Permit #. 16 103002 00-EL
Community&Econ.Dev.Services •
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-3050
Project Name: MIRROR LAKE ELEMENTARY SCHOOL NORTH
Project Address: 625 S 314TH ST Parcel Number: 082104 9035
Project Description: Install low voltage data cabling for portable classroom.Install fiber optic backbone.Install
AV cabling only.
Owner Applicant Contractor
FEDERAL WAY PUBLIC SCHOOLS INTRACOMMUNICATION NTWK SYS IN INTRACOMMUNICATION NTWK SYS IN
33330 8TH AVE S (INSI) (INSI)
FEDERAL WAY WA 98003-5433 4922 N PEARL ST INTRANS994JL(4/10/17)
TACOMA WA 98407 4922 N PEARL ST
TACOMA WA 98407
•
Additional Permit Information
Electrical Work Valuation? 11000.00 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 Wednesday, June 21, 2017
Permit Issued on Tuesday, June 21, 2016
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 accord e with the laws, rules and regulations of the State of Washington
nd the City of Federal Way. /
Owner or ag t: Date: =��" .2 c y
UtALBD
401& THIS CARD IS TO REMAIN ON-SITE
sp
FederallA/a Construction Inection Record
Y INSPECTION REQUESTS: (253)835-3050
PERMIT#: 16-103002-00-EL Address: 625 S 314TH ST
Project: FEDERAL WAY PUBLIC SCHOOLS FEDERAL WAY, WA 98003-5214
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.
0 LIFER Ground(4295) - El Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) 0 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
0 Feeders/Sub-panels(4045) 0 Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
El Final-Electrical(4055)
Approved
By t-3 Date T(gI (a,
0 Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF ELECTRICAL
Wm"Illiftwoo`Federal WayRECEIVED PERMIT APPLICATION
ION
JUN 21 2015 0 00 00
CITY OF FEDERAL WAY PERMIT NUMBER A:, _ Z _
CDS — — — —
SITE ADDRESS: dP25 isi SUITE/UNIT/SPACE#
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ '4„-�- 0---"`- o 8 a 1 041- _ 90 ,.3S-
PROJECT
NAME /�
(Tenant or Homeowner Last Name) ,��l csse!e�'A sS lts�7 /' ' 4. 4/4'h a3 AVe-1 14'4." / �l O
A/1.0vsoe.ae.i� "A/41.d ( .O417 �, Z7 C'„>6Af�-y JJ .2f;"i_es.dli t
PROJECT DESCRIPTION -r/ , -..7°/e--/ze-eeJ i. 5 i' 2s/%4;„0 au/7
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER -L Gv. Scl / 4Of4f.1 (-2-5:3) '01- S13-S
MAILING ADDRESS E-MAIL
333-3e) ,4-v< 3 ei- /*/.,;,/t/f/z. .:3fi,,y,1.0x.1.7
CITY STATE ZIP FAX
- 40G1 9F ( ) -
NAME / PRIMARY PHONE
. •t/..3 _ (2s3 ) 7// - eV/'
MAILING ADDRESS E-MAIL
ELECTRICAL V22 A/6 /4ted4/.S7. 1 ie,e 18 i%v1`-'eadu",ee Al'
CONTRACTOR CITY STATE ZIP FAX
'izLatura, w/' / /4/ 7 (1)3 ) J ,'- d/16
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
�.U7 ,,.1 9y,,z_ y/ /0 1/7
NAME PRIMARY PHONE
APPLICANT /441-4",
-i 1 (213 )7// - de/V?
MAILING ADDRESSE- L
V,-2- ,/.../eir71", °e.#0 -/.c/. /#.. I /mss.'. /, ,
CITY STATE ZIP FAX
7iX�iyr41, I 9/141 7 (2f3 )f'f- 4/9d
NAME PRIMARY PHONE
PROJECT CONTACT �ip.fza eudr'i1 21�
y ( ) 732 -S3Y./-
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 o the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the ci as a • . of this application.
SIGNAT. - f 7�/lIllIl
DATE 6-a/< "'ZD/C
PRINT NAME: G,Gek_ eA°
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application