15-103631RI§EIVED
`,�oF 0 PERMIT PPLICATION
Federal Way JUL 2 3 2015
CITY OF FEDERAL WAY
PERMIT NUMBER J— I S ()
– 0 L u TARGET DATE � Z � � ✓
SITE ADDRESS
SUITE/UNIT M
27203 Pacific Hwy South; Federal Way, WA 98003
PROJECT VALUATION
ZONING ASSESSOR'S TAX/PARCEL M
$ 45,000.00
BC (Community 3322049055
Business)
TYPE OF PERMIT
X❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
$26931 T -MOBILE - SE04020D - REDONDO
(3) panels for (3) new panels; Adding (3) FRLBs.
FINAL CONFIGURATION of: (6) panels, (12) Coax Cables, (1) Hybrid Cable, (3) FRLBs, (3) FRIGs, (2)
PROJECT DESCRIPTION
FXFBs 6 Di lexers 6 TMAs 1 COVP.
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
CHAMBERLAIN PROPERTIES
MAILING ADDRESS
E-MAIL
27203 Pacific Hwy South
CITY
STATE
ZIP
Federal Way
WA
98003
NAME
PHONE
TBD
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE M
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE M
NAME
PRIMARY PHONE
T -MOBILE / CROWN CASTLE
206-336-2867
MAILING ADDRESS
E-MAIL
APPLICANT
1505 Westlake Avenue North; Ste 800
Andi.Spencer.Contractor(a)crownc
astle.com
CITY
STATE
ZIP
FAX
SeattleWA
98109
NAME
PRIMARY PHONE
Andi Spencer on behalf of Crown Castle
206-336-2867
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
1505 Westlake Avenue North; Ste 800
Andi.Spencer.Contractoroacrownc
respond to all correspondence
concerning this application)
astle.com
CITY
STATE
CITY
STATE
Seattle
WA
Seattle
WA
PROJECQ FINANCING
t
Required value of $5,000 or more
NAME
T -Mobile
❑ OWNER -FINANCED
Bulletin #100 — January 1, 2013 Pagel of 3 k:AHandouts\Permit Application
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
FIRST
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILER(S)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
■ `FIXTURES
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERT(S) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S) URINAL(S) WATER HEATER(S)
RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
SHOWER(S) WASH MACHINE OUTLET
SINK(S) WATER CLOSET(S) MISC. ( )
SUMP(S)
'%TCCI ATMFR /CTPNATURF RLC
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and
further, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of
Federal Way, but only where such claim ises out of the reliance of the city, including its officers and employees, upon the accuracy
of the information supe city apart of this application.
pli d
NAME/TITLE: ca,SJ < DATE: Q
❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
COMMI 1NiTY nFVF1 OPMENT SERVICES • 33530 FIRST WAY SOUTH • P.O. BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 2S3-661-4129
r
M`
CITY, STATE, ZIP
PHONE
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 a part of this application.
SIGNATURE: Art�r!� err 6aiGcz�l� B�( �ee�vsL C DATE 07/15/2015
Bulletin #100 —January 1, 2013 Page 2 of 3 k:AHandouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each type offtcture to be installed or relocated as part of this project. Do not include existingftxtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commerow)
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
FOR OFFICE USE
BASEMENT
AREA DESCRIPTION
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet(
EXISTING FIRE SPRINKLER SYSTEM?
Indicate how many of each type o
re to be installed or relocated as
part of this project. Do not include exist' res to remain.
BATHTUBS (or Tub/Shower 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 FDMURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
FOR OFFICE USE
BASEMENT
AREA DESCRIPTION
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet(
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
in Square Feet
Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
AREA DESCRIPTION
Occupancy Group(s)
FIRST FLOOR (or Mobile Home)
Additional Information
in Square Feet
SECOND FLOOR
Stories
NEW BUILDING
COVERED ENTRY
ADDITION
DECK
.......................... _......................................... __.._...�......_.
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area
......................... -.................................................. _... __... _..........
Area Totals
EXISTING
PROPOSED
TOTAL
-------------_._. _.. ................. _..
*'HEW HOMES ONLY**
ESTIMATED SELLING PRICE $
1 # OF BEDROOMS
COMMERCIAL — NEW/ADDITION
Area
Construction
# of
AREA DESCRIPTION
Occupancy Group(s)
Additional Information
in Square Feet
Type
Stories
NEW BUILDING
ADDITION
COMMERCIAL — REMODEUTENANT IMPROVEMENTS
Area
Construction
# of
AREA DESCRIPTION
Occupancy Group(s)
Additional Information
in Square Feet
Type
Stories
100 ft
Cell Tower
TOTAL BUILDING
Monopole
Existing
TENANT AREA ONLY
233 sq ft
Lease Area
PROJECT AREA ONLY
Lease Area
Existing
Bulletin #100 - January 1, 2013 Page 3 of 3 k:\Iiandouts\Permit Application