12-103007Project Name: VERIZON WIRELESS - SEA AURROR LAKE
Project Address: 33414 21ST AVE SW
Ouilding - Commercial
Permit #:12 -103007 -00 -CO
Inspection Request Line: (253) 835,3050
Parcel Number: 132103 9062
Project Description: ADD - Modify existing rooftop telecommunication facility by adding (2) new omni antennas
and (1) new equipment cabinet.
Owne
ARRlicapA
Contractor
City of Federal Way
VERIZON WIRELESS
Community & Econ. Dev. Services
33325 8th Ave S
T ;
"'zll
Federal Way, WA 98003
TELECOMMUNICATIONS INC
Ph: (253) 835-2607 Fax (253) 835-2609
(GENERAL)
Project Name: VERIZON WIRELESS - SEA AURROR LAKE
Project Address: 33414 21ST AVE SW
Ouilding - Commercial
Permit #:12 -103007 -00 -CO
Inspection Request Line: (253) 835,3050
Parcel Number: 132103 9062
Project Description: ADD - Modify existing rooftop telecommunication facility by adding (2) new omni antennas
and (1) new equipment cabinet.
Owne
ARRlicapA
Contractor
Lender
VERIZON WIRELESS
LEGACY
OWNER IS LENDER
15900 SE EASTGATE WAY
TELECOMMUNICATIONS INC
BELLEVUE WA 98008
(GENERAL)
LEGACT1005KD (6/l/13)
PO BOX 360
BURLEY WA 98322
Census Category: 999 - Unknown
Includes: #1 #2 #3 #4
Occupancy Class.
Construction Type:
Occupancy Load-
Floor
oadFloor Area . f 0 0 0 0
AdcridorW Pimit Ia an
Mechanical to be Included?...................................No Number of Stories. ................................................. 1
Permit for Building Shell Only?............................No Plumbing to be Included? ...................................... No
New / Additional Sq. Feet - Total .......................... 0 Zoning Designation...............................................RS 5.0
No Fbduies Assoc * h This Permit 11
PERMIT EXPIRES Tuesday, November 5, 2013
Permit Issued on Thursday, May 9, 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. _ q
Owner or agent: Date:
FINA[-,F-.D
r •
Y COW
Federal Way
u I-t1u
THIS CARD IS TO ON-SITE
Construction In ectiI Record
INSPECTION REQ TS: (253) 835-3050
12 -103007 -00 -CO Address: 33414 21ST AVE SW
Project: VERIZON WIRELESS FEDERAL WAY, WA 98023-7761
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
SWM Precon Site Mtg ()
Initial Erosion Control (4 65)Footings/Setback
Final Electrical
Approved
(4110)
Approved
By
To be done prior to breaking ground
Approved to place concrete
By
Date
By
Date
By
Date
o Final Erosion Control (4375) 0 Final - Building (4050)
Approved Approved
By Date S Date C�J3
Foundation Wall (4115)
Drainage/Downspout (4040)11
Final Electrical
Approved
Re -steel (4215)
Approved to place concrete
By
Approved to backfill
Approved to place concrete or grout
By
Date
By
Date
By
Date
0
Floor Sheathing (4105)
Underfloor Framing (4285)
Slab/Concrete Floor (4255)
Approved to place concrete
Approved to sheath floor
Approved to install flooring
By
Date_% 2
By
Date
By
Date
Shear Walls (4245)
0
Roof Sheathing (4220)
Fire/Draft Stops (4095)
Approved to install siding
Approved to install roofing
Approved
By
Date
By
Date
By
Date
eduling a F inspection;
Framing (4120)
0
Interim Erosion Control (4370)FFir&lh-aft
Approved
bing & Mechanical Rough -in and
Approved to insulate
Date
inspections must be signed -off andBy
By
Date
pproved. IBC 1093.4
❑
Suspended Ceiling Grid (4265)
Gypsum Wallboard Nailing (4130)
Insulation (4150)
Approved to install wallboard
Approved to install mud & tape
Approved to drop tile
By
Date
By
Date
By
Date
0
Final - Planning
Final - Public Works (4080)
Final - Fire Department (4060)
Approved
Approved
Approved
By
Date
By
Date
By
Date
o Final Erosion Control (4375) 0 Final - Building (4050)
Approved Approved
By Date S Date C�J3
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
j
MY OF V& �'(\ f
Federal *� C 1 V A w PERMIT
COMMUNrrY (] DEVELOPMENT SERVI n ZO1//� pPLICATION
253-835-2607• FqX 253-835-2(;0 G �7 ��"11LL ii
uauu' d1wj(f dcrah-ii coin' `
rrTTY OF FEDERAL WAY
SITE ADDRESS
3361.6 21st Avenue SW
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL #
$30,000 RS 5.0 1321039062
TYPE OF PERMIT N BUILDING ❑ PLUMBING
❑ DEMOLITION ❑ ENGINEERING
NAME OF PROJECT
1Tenantivame/Homeowner Last Name) Verizon Wireless - SEA Mirror Lake
18
SF M Co E -PL DE EN FP
SUITE/UNIT #
❑ MECHANICAL
❑ FIRE PREVENTION
PROJECT DESCRIPTION
Detailed description of ulork to 70mnintennas and one (1) new equipment cabi
be included on this permit only
NAME
PROPERTY OWNER South King County Fire & Rescue
PRDdARYPHONE
MAD.iNG ADDRESS
FAX
31617 1st Avenue South
E-MAIL
CITY STATE ZIP
Federal Way
(Agent)
WA 98003
PHONE
NAME
TBD
PHONE
MAII,D�A.DDRFMI�.�
E -MAH,
CONTRACTOR
E MAII
CITY
STATL ZIP
FAX
APPLICANT
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
PROJECT FINANCING
Required value of $5,000 or more
(RCW 19.27.095)
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE #
NAME
Verizon Wireless
MAILING ADDRESS
15900 SE Eastgate Way
CITY
Bellevue
NAME
RealCom Associates - Sarah Telscho
MAII, VG ADDRESS
14432 SE Eastgate Way, Suite 260
CITY
Bellevue
ALTERNATE CONTACT NAME;
NAME
Not Applicable
MAILING ADDRESS, CITY, STATE, ZIP
Not Applicable
PHONE
w
E-MAM
STATE
ZIP
FAX
WA
98008
(Agent)
PHONE
(425) 274-4444 ext. 114
E -MAH,
steischOW@realcomassoc.com
STATE
ZIP
FAX
WA
98007
(425) 274-4449
PHONE
E-MAEL
OWNER -FINANCED
PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certM that to the best
of my knowledge, the irtformation 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 a� defense of h claim), which may be made by any person, including the undersigned, and filed against the city,
but only where suc claim o teliance o the city,
irtforrrtation suppli to the cI part of this 4Pplicatrfon. including its officers and employees, upon the accuracy of the
06-19-12
PRINT
Bulletin #100 — Jammy 1, 2011 Page I of 3
k:\Handouts\Permit Application
. )0_t, 0 0
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type off vture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial)
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS (or nub/shower combo)
LAVS (Hand sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/Utility)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
-77
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTSN o N /A N /A $ Not Known
EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
AREA DESCRIPTION (in square feet) I EXISTING I PROPOSED I TOTAL
FIRST FLOOR (or Mobile Home)
COVERED ENTRY
FOR OFFICE USE
Bulletin #100 -January 1, 2011 Page 2 of 3 k: flandouts\Permit Application