12-101111 Mechanical
City of Federal D Way Permit #: 12-101111-00-ME
Community&Econ.Dev.Services
33325 8th Ave S
Federal Way,wA3
Inspection Request Line: 253 835-3050
Ph:(253)835-2607 Fax:(253)53)835-2609 P q
Project Name: CEDAR CREEK CONDOMINIUM UNIT 35
Project Address: 32820 20TH AVE S Unit 35 Parcel Number: 144170 0350
Project Description: Relocate meter and extend gas line
,
Owner Applicant Contractor
DEAN A JACOBUS INFRASOURCE CONSTRUCTION LLC INFRASOURCE CONSTRUCTION LLC
32820 20TH AVE S UNIT 35 8001 S 212TH ST INFRACL899CZ(2/14/13)
FEDERAL WAY WA 98003 KENT WA 98032 8001 S 212TH ST
KENT WA 98032
Additional Permit Information
Mechanical Valuation 1000.00 Is this an Online or O.T.C.application Yes
Mechanical Fixtures
Gas Piping 1
PERMIT EXPIRES Saturday, September 8, 2012
Permit Issued on Monday, March 12, 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
the City of Federal Way.
Owner or agent: '' ,f ., Date:
�► 4/4/17-
1THIS CARD IS TO AIN ON-SITE .
CITY OF
Construction In ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 12-101111-00-ME Address: 32820 20TH AVE S Unit 35
Project: DEAN A JACOBUS FEDERAL WAY, WA 98003-9430
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 5;2/05./ Approved
By Date By /4 Date V - /-7 Z By Date --y-/2....,
0 Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
lz- ( 0 I I ► ►
CITY OF .f `PERMIT
410:4-;FederaWay co
COMMUNITY DEVELOPMENT SERVICES APPLICATION �„� tTIED FP
253-835-2607-FAX 253-835-2609
wwwrituoff'deral wail.corn
MAR 0 8 2012
SITE ADDRESSb.
CITY OFT:. 'i. ALWAY
Y
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 1 ,000 14 LI J `j 0 - 0 0 0 0
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING pp MECHANICAL
❑ DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT
(T /_ _ &Pp
/ rIVI U
(Tenant Name/Homeowner Last Name) l.'/''7/� I
PROJECT DESCRIPTION Fut 1 '14` eq-- +0 rh o vi: 5 u S rhe dt r a n by in '
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
`- CITY - J STATE 1 ZIP
. _ _ _ _ - I ___Y__ __ _ .. ... _
NAM
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PHONE
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MAILING ADDRESSE-MAIL
CONTRACTOR laR oos eve 1+ R a .�re 400 STATE
ZIP
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Ckcrt : I 1\ 1 •j,l., �V� FAX
IA 7
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
tvfaaGi-93gc-i csx/ L9 /act3 100 9 8
NAME.'
EVc Tohnv1 ► _ PHONE
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APPLICANT MAILINGDRESS E- L
Bol/ { w l-h ^a{.1 a fh S i"rce}-
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PROJECT CONTACT NAME
(The individual to receive and �
�eVG J h" PHONE
�n )15-3-.370-a'ci I
respond to all correspondence AD RESS t-4E-MAILL
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concerning this application) 0 50 �'1 a ---A S C e
CITY STATE ZIP FAX
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ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAM (� '"
Required value of$5,000 or more 51.1 frq Scu CC COnS fi"14 C}�OK I f Co 0 OWNER-FINANCED
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
la°e R ooscvcl f (2 t) Ste W(3° Glen Eilyn ,. G30- Gla 35-18
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 ci - a part of this application. ,QQ/
SIGNATURE: /// DATE /V! . .ol a
PRINT NAME: S 4-cove,4-cove, l9h n Sc rl
Bulletin#100—January I,2011 Page 1 of 3 k:W andouts\Permit Application