12-101083 • i Mechanical
City of Federal Way
Community&Econ.Dev.Services Permit #: 12-101083-00-M E
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line:
Ph:(253)835-2607 Fax:(253)835-2609 p q (253)835-3050
Project Name: CEDAR CREEK CONDOMINIUM UNIT 16
Project Address: 32820 20TH AVE S Unit 16 Parcel Number: 144170 0160
Project Description: Relocate meter and extend gas line
Owner •
Applicant Contractor
VICKI M SHUMAKER INFRASOURCE CONSTRUCTION LLC INFRASOURCE CONSTRUCTION LLC
32820 20TH AVE S UNIT 16 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
t Ci ederal Way.
Owner or agent: Date:
°KIM> 3f#O//L.
THIS CARD IS TO MAIN ON-SITE
CITY°F Construction In ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 12-101083-00-ME Address: 32820 20TH AVE S Unit 16
Project: VICKI M SHUMAKER FEDERAL WAY, WA 98003-9429
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) 0 Gas Piping(4125) ❑ Final-Mechanical(4065)
Approved Approved to release test ZOO„vs/ Approved
By Date By Date 3-34-/Z By ( t'/C Date 3'31). /z_
•
0 Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
*PERMIT
Federal Way s EN FP
COMMUNITY DEVELOPMENT SERVICES APP I. C A T I O N
253-835-2607•FAX 253-835-2609 8 �j 1
www.cityvfled era1wau.com MAR (, 1
SITE ADDRESS CITY OF F/E''DFFRAL WAY
3ac3 aiLs
ga "'"
vc 5 VJ/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ I ,000 14 4 i - 0 - 0 0 0 0
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING pp MECHANICAL
0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT ^��
(Tenant Name/Homeowner Last Name)([� � CIOPPC..... C�j�W F1/A''' > C s 01De-C, ..
PROJECT DESCRIPTION If "4& ( (1't` et
/ - +0 (h oo`ve, y t4 S �rhevt1 r a fl horn Q
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAMB.r PHONE .—
n Prot source cal 6tYinc.HvnI G
MAILING ADDRESS E-MAIL
CONTRACTOR la0O Roos eve 1+ Q a •S i-e coo
�
FAX
ltcr r I/kill tL (.0111
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
W1► _ c./...0,RG7- - ty / it- /aot3 lea ,S:
NAME..." ' -eve Tohn Y1 PHONE
SV Ic'3-3'7 t2-- an
APPLICANT MAILING ADDRES6 E-MAIL
amSof 'al ae SvrceA-
cITYtc-en wT, ZI' 803 a. FAX
PROJECT CONTACT NAME PHONE
-1--eve JOhnson °
(The individual to receive and ,s'3-3?(��a Gl q'
respond to all correspondence MAILING AD RES5 wS E-MAIL
concerning this application) 00f1 7L h 3 r t-i S e e-iL
CITY' l 11 STATE ZIP 60- FAX
KL 7L IA/�` ci
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING
NAM -_--
Required value of$5,000 or more �el fret Sk1ICGL (..on S fru ctiot,‘ f/G ❑ OWNER-FINANCED
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
1a.oe (3 ooScvel fi' R Q Ste LitN) Glen E11yn i 1•3O' 61r 3518
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.
SIGNATURE: � DATE /8/a'o i ..
PRINT NAME: S 4-04/6 /Oh n sin
Bulletin#100—January 1,2011 Page 1 of 3 k:\Ilandouts\Permit Application