12-102459City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835 -2607 Fax: (253) 835 -2609
Project Name: CAMELOT SQUARE MHP - SPACE 332
Project Address: 3001 S 288TH ST Space 332 6
Project Description: Relocate meter and extend gas line
0
Mechanical
Permit #: 12- 102459 -00 -ME
Inspection Request Line: (253) 835 -3050
Parcel Number: 042104 9155
Owner
AR lid
Contractor
CAMELOT SQUARE INC
INFRASOURCE CONSTRUCTION LLC
INFRASOURCE CONSTRUCTION LLC
3001 S 288TH ST
1200 ROOSEVELT RD SUITE 400
INFRACL899CZ (2/14/13)
FEDERAL WAY WA 98003 -8019
KENT WA 98032
1200 ROOSEVELT RD SUITE 400
KENT WA 98032
Mechanical Valuation ................... ........................1000.00 Is this an Online or O.T.C. application? ................. Yes
Mechanical Fixtures
GasPiping ....... ............................... 1
PERMIT EXPIRES Tuesday, November 27, 2012
Permit Issued on Thursday, May 31, 2012
I hereby certify that the above information is correct and that the construction on the above described properly 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.
Owner or agent: I a J= Date:
I LM am
F1NMWQ> d 011f1ra
THIS CARD IS TO MAIN ON -SITE
CITY CF Construction In ection Record
Federal Way INSPECTION REQU TS: (253) 835 -3050
PERMIT #: 12- 102459 -00 -ME Address: 3001 S 288TH ST Space 332
Project: CAMELOT SQUARE INC FEDERAL WAY, WA 98003 -8019
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.
Mechanical Rough -in (4165)
Gas Piping (4125)!G
Final - Mechanical (4065)
Approved
Approved to release test Ps/
Approved
By Date
By )e:� - Date ?,Ir -IZ
By ff7G Date % 1pq?
El
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CIroF RECEIVED *ERMIT
Federal WciSi
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COMM E 7253 - 835 -2 0.,,,5,,3,-, 31 M APPLICATION
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CITY OF FEDERAL WAY
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SITE ADDRESS
SUITE /UNIT #
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PROJECT VALUATION
ZONING
ASSESSOR'S TAR /PARCEL #
000
-
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING AMFXHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name /Homeowner Last Name)
PROJECT DESCRIPTION
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Detailed description of work to
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be included on this permit only
PROPERTY OWNER
NAME
/
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PRIMARY PHONE
MAILING ADDRESS
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STATE
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CONTRACTOR
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STATE
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ZIP
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FAX
WA STATE CONTRACTOR'S LICENSE #
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EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME[�
Jd'�M� t� AJKOW
PHONE
APPLICANT
MAILING ADDRESS
E -MAIL
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CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME�C� /I .02 p U N
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(The individual to receive and
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respond to all correspondence
concerning this application)
CITY
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STATE
Wa
ZIP
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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.
SIGNATURE• DATE
PRINT NAME: E/ y 7 BIZ �O tV
Bulletin #100 —January 1, 2011 Page I of 3 k:\Handouts\Permit Application
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Mk.icHA�t1C� . F1xTuREs
VALUE OFMECRAMCAL WORK $ /000 (a copy of bid or estimate must be provided)
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.
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 Z GAS PIPING WOODSTOVES
W.
GE�ERt1L LNFORIvLATIONT
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING /PREVIOUS USE I LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM? I PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
Bulletin #100— January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application
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 Tub/ Sbo— Combo)
LAVS (Hand Sinks) TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS
SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitcbm /unbty) WATER HEATERS (Electric)
HOSE BIBBS
SUMPS WASHING MACHINES TOTAL FIXTURES
W.
GE�ERt1L LNFORIvLATIONT
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING /PREVIOUS USE I LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM? I PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
Bulletin #100— January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application