12-102460I
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835 -2607 Fax: (253) 835 -2609
Mtx chafticai
Permit #: 12- 102460 -00 -ME
Inspection Request Line: (253) 835 -3050
Project Name: CAMELOT SQUARE MJIP - SPACE 395
Project Address: 3001 S 288TH ST Space 395 Parcel Number: 042104 9155
Project Description: Relocate meter and extend gas line
Owner
Agnlicant
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
Additional Permit Information
Mechanical Valuation .................... ........................1000.00 Is this an Online or O.T.C. application ?................ Yes
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 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.
Owner or agent: Date:
rILM
Fn��v =Aallz
CITY OF
Federal Way
THIS CARD IS TO MAIN ON -SITE `
Construction In ection Record
INSPECTION REQU TS: (253) 835 -3050
PERMIT #: 12- 102460 -00 -ME Address: 3001 S 288TH ST Space 395
Project: CAMELOT SQUARE INC FEDERAL WAY, WA 98003
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 Mechanical Rough -in (4165)
Gas Piping (4125)
0 Final - Mechanical (4065)
Approved
Approved to release test a PSI
Approved
By Date
By Date 7 - Ig./Z
By GAG Date 7-/P—/Z-
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF E O'ERMIT
Federal Vila CEIV
ral ED
COMMu!Nv:"wY. DEV E -
APPLICATION
253- 835 -207• FX P2M53N3S5E2 R §31 2Qt6luoffederalwau. com
CITY OF FEDERAL WAY
_ O 2 (o 0
S F CO QE PL DE EN FP
Iflsq -s-
SITE ADDRESS
SUITE /UNIT N
3 oo i 5 ZS 8`q 5-r- Fe AO C r4-c- w 'W01 0/ S o0 3
3 9S
PROJECT
ZONING
ASSESSOR'S TAR /PARCEL i
/ �j��yy//V����ALUATION
O co
-
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING AMECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name /HomeoumerLast Name)
��� / _ T s / 1 . . �_ � &yam, Imo` PAS- le-
,T+
1�0 ISL/V�
C-7.4--C t,?) �U C! l
PROJECT DESCRIPTION
Detailed description of work to
C,-iS / 0 /✓
be included on this permit only
PROPERTY OWNER
NAME
PRIMARY PHONE
MAILING ADDRESS
3001 S
E-MAIL
CITY
Feo
STATE
r ZIP
of eoo3
NAME
acNr- ,2i4source_ �ons�. LLC
PHONE
�30��3
MAILING ADDRESS
1 Z o o 4oD.S e- ✓ e-- L r- eo S TE +OCU
E-MAIL .
-
CONTRACTOR
{� ' Gn G I A/
STATE
1(.e
ZIP
&01-4-7
FAX
WA STATE CONTRACTOR'S LICENSE k
rNJ=P -ACL Sqa C-Z
EXPIRATION DATE
Z i l +/,
FEDERAL WAY BIISINESS LICENSE B
NAME
PHONE
APPLICANT
MAILING ADDRESS
E-KAIL
-
CITY
STATE
2IP
FAX
PROJECT CONTACT
76
tY ��2p V N
PHONE ,/ /
Z`�3 Tq s -7 03 a0
(The individual to receive and
MAkLING ADDRESS
00 1 5 2-1 Z-:6(--S T
F-MAIL Er/E12( prV r
My
respond to all correspondence
concerning this application)
C
4-117-
STATE
wa-
i% 0 3 Z
FAR
ALTERNATE CONTACT NAME:
PHONE
E -MAIL
PROJECT FINANCING
NAME
El 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 — Z
PRINT NAME: /V
Bulletin #100 - January 1, 2011 Pagel of 3 k:\Handouts\Permit Application
GENERAL LN ORI IATI01�',
I CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING /PREVIOUS USE I LOT SIZE )In Sqn a Feet)
EXISTING FIRE SPRINKLER SYSTEM? I PROPOSED FIRE SUPPRESSION SYSTEM?
o Yes o No o Yes o No
AREA DESCRIPTION
Mkca NIC. ,. IXTUREs ..
VALUE OF MECHANICAL 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 res to remain.
AIR HANDLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS HOODS (co nmereial)
BOILERS
FURNACES HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
GENERAL LN ORI IATI01�',
I CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING /PREVIOUS USE I LOT SIZE )In Sqn a Feet)
EXISTING FIRE SPRINKLER SYSTEM? I PROPOSED FIRE SUPPRESSION SYSTEM?
o Yes o No o Yes o No
AREA DESCRIPTION
; 'LUMBL G. FIYTLT tES
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 Ttb /shove :Combo)
LAVS (Hand Sinks) TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS
SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen /utwty) WATER HEATERS (Ei «tro)
HOSE BIBBS
SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL LN ORI IATI01�',
I CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING /PREVIOUS USE I LOT SIZE )In Sqn a Feet)
EXISTING FIRE SPRINKLER SYSTEM? I PROPOSED FIRE SUPPRESSION SYSTEM?
o Yes o No o Yes o No
AREA DESCRIPTION
Area
Occupancy Group(s)
Construction
# of
Additional Information
in Square Feet
Type
Stories
NEW BUILDING:
ADDITION
NIE� L,EL`i��T h
i - R6
T-CO
AREA DESCRIPTION
Area
Occupancy Group(s)
Construction
# of
Additional Information
in Square Feet
a
Stories
TOTAL, BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 —January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application