12-101588Mechanical
City of Federal Way _ 9 Permit #. 12- 101588 -00 -ME
Community & Econ. Dev. Services
33325 8th Ave S ?��!
Federal Way, WA 98003
Ph: (253) 835 -2607 Fax: (253) 835 -2609 p T 4 Ins ection Request Line: 253 835 -3050
Project Name: RUSSOM
Project Address: 2825 S 301ST ST Parcel Number: 798490 0020
Project Description: Relocate gas meter.
Owner
AplIlican
Contractor
SALLY RUSSOM
INFRASOURCE CONSTRUCTION LLC
INFRASOURCE CONSTRUCTION LLC
2825 S 301ST ST
8001 S 212TH ST
INFRACLS99CZ (2/14/13)
FEDERAL WAY WA 98003 -4240
KENT WA 98032
8001 S 212TH ST
KENT WA 98032
Additional Permit information
Mechanical Valuation ................. ...........................1000
Is this an Online or O.T.C. application ? .................Yes
Mechanical Fixtures
Gas Piping ....... ............................... 1
PERMIT EXPIRES Saturday, October 6, 2012
Permit Issued on Monday, April 9, 2012
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
t Ci of Federal Way.
Owner or agent: Date:
�-� */((/12.
CITY OF 04►%
Federal Way
PERMIT #:
Project:
THIS CARD IS TO MAIN ON -SITE
Construction I ection Record
INSPECTION REQ TS: (253) 835 -3050
12- 101588 -00 -ME Address: 2825 S 301ST ST
SALLY RUSSOM+ FEDERAL WAY, WA 98003 -4240
Scheduled inspections may be failed if this card is not on -site. D&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.
Mechanical Rough -in (4165)
Gas Piping (4125)
Final - Mechanical (4065)
Approved
Approved to release test
Approved
By Date
By Date
By Date
Date
w _
lT
Rough Electrical
Approved
Final Electrical
Approved
11
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF RECE#FE)RM1T
Federal Way
COMMUNITY DEVELOPMENT SERVICES
253 -835 -2607• FAX 253- 835 -2609 A PR M
P P L
I C AT I O N
AIU'A'. TTY VF FEDERAL WAY
• MF CO ME PL DE
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EN FP
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SITE ADDRESS
SUITE /UNIT N
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2. 2� o) s(
PROJECT VALUATION
ZONING
ASSESSOR'S TAX /PARCEL N
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING XMECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name /Homeowner Last Name)
PROJECT DESCRIPTION
CLc, .� r� r F &YA ' e/�'1
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
I
MAILING ADDRESS 6T-
Z81Z Cp
E -MAIL
CITY n
FCD° A S _
STATE
ZIP
NAME
T—N FQA
PHONE
MAILING ADDRESS
19:330 S 164l ✓4-
CONTRACTOR
CI �
V dTATE r n
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ZIP �3
FAX
WA STATE CONTRACTOR'S LICENSE x
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE M
NAM& //� �,�, (/� 1,
F� Vim.
PHONE
2 V7 J
MAILING ADDRESS
CcI T•L7 '�g C �1'C-
E -MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
PHONE
(The (The individual to receive and
�T �p UC' rz_
MAILING ADDRESS
eZr,_j T (7_AC'C -'Ie--
E -MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E -MAIL
PROJECT FINANCING
NAME
OWNER - FINANCED
Required value of $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
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.
�y
SIGNATURE: DATE
PRINT NAME:
Bulletin #100 -January 1, 2011 Page 1 of 3 k:\Handouts\Permit Application
VALUE OFMWHAMCAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as Rart 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 fvdure to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS (o Tub / shower combo)
LAYS (Hand Sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchm /utilit}�
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
Bulletin #100 — January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application