14-105657At
4. ELECTRICAL
CITY OF
Federal Way PERMIT APPLICAMON
14-00 OCT 342014 1 j��
PERMIT NUMBER
— — CITY OF -DERAL WA
SITE ADDRESS: 30611 16th Ave S Federal Way, WA 98003
SUITE/UNIT/SPACEN
PROJECT VALUATION
ASSESSOR'S TAX/PARCEL M
CURRENT/PROPOSED USE
$ 8,350,000
0 8 2 1 0 4- 9 0 0 1
High School
PROJECT NAME
(Tenant or Homeowner Last Name)
Federal Way High School
Provide electrical connections and services related to construction of new
High School.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRnWARY PHONE
PROPERTY OWNER
Federal Way Public Schools
( 253 ) 945-2000
MAILING ADDRESS
E-MAIL,
33330 8th Ave S
smclean@fwps.org
CITY
Federal Way
STATEZI
WA
198P003
FAX
( ) _
N S
PRIMARY PHONE
l )
MAILING ADDRESS
E-MAII.
ELECTRICAL
CITY
STATE
ZIP
FAX
CONTRACTOR
TBD
( ) -
WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE M
APPLICANT
NAME
Federal Way Public Schools
PRIMARY PHONE
( 253) 945-2000
MAILING ADDRESS
E-MAIL.
33330 8th Ave S
smclean fw s.or
CITY
STATE
ZIP
FAX
Federal Way
IWA
198003
( ) -
PROJECT CONTACT
NAME
Ingrid Krueger, SRG
PRIMARY PHONE
( 206) 973-1692
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 apart of this application.
SIGNATURE: �. �. i/ I'I
PRINT NAME:
Bulletin #160 — January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application