12-101089 • Mechanical
City of Federal Way Permit #: 12-101089-00-ME
Community&Econ.
D
ev.Services
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-3050
Project Name: CEDAR CREEK CONDOMINIUM UNIT 21
Project Address: 32820 20TH AVE S Unit 21 Parcel Number: 144170 0210
Project Description: Relocate meter and extend gas line
Owner Applicant Contractor
JAMES&SANDRA BLOKZYL INFRASOURCE CONSTRUCTION LLC INFRASOURCE CONSTRUCTION LLC
32820 20TH AVE S UNIT 21 8001 S 212TH ST INFRACL899CZ(2/14/13)
FEDERAL 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
and the City of Federal Way.
Owner or agent: FIL. EDate:
F t1��JU.A 3M ftz.
THIS CARD IS TO MAIN ON-SITE ,
CITY OF Construction I ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 12-101089-00-ME Address: 32820 20TH AVE S Unit 21
Project: JAMES & SANDRA BLOKZYL 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.
❑ Mechanical Rough-in(4165) -❑ Gas Piping(4125) 0 Final-Mechanical(4065)
Approved Approved to release test Approved
/
By Date • `By / t Date 3-l9-/•Z • 'By r(/r Date 3,/9—/�,
•
❑ Rough ElectricalEl Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
_ ( 2 - ( 0 1 O Ecj'
PERMIT J
Federal Way S MF} cO P a >; > v FP
COMMUNITY DEVELOPMENT SERVICES APPLICATION
253-835-2607•FAX 253-835-2609 �� 2 12
wu ui.r..'!yotTede.rahuaucoin
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ICYSITE ADDRESSOF
cl
FEDERAL WAY
3a18a0 a.c*n4vc 5 SU yr#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 11000 1 4 II I 7 C) - 0 0 0 0
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING • MECHANICAL
❑ DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT �//�����
(Tenant Name/Homeowner Last Name) l � P _ eegtC__ 0
O�/I J>0 VI/�\l 1I ' J -i
PROJECT DESCRIPTION
Full role- C1. -- +D tho v& Vi r.,srhe cI- r' VNMI co fl I Q
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY �1 STATE ZIP -
... N i i I Fru S0L1rd.e. CoAStrVIGPVh I G PHONE
MAILING ADDRESS
E-MAIL
CONTRACTORROO R ooS eVe I} R e .01 e M cep
cITct rr 1111n STATE ZIP FAx
` r 013""/
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
�NP A A C19/ 1C-7- ty ,' 19 f aol l loci -
NAME,- PHONE
'eve Toh r bp1 is 3_-3-7(?-- an 1
APPLICANT MAILINGDRES6
800 I so,4 1 aiaf.h St-req-
CITY
E-MAIL
CITY tc't n `A's ZIP 8o
S
FAX
PROJECT CONTACT NAME ,I V ,/7T 9 PHONE G
(The individual to receive and �w� Jh"�'"n c)173-3.7(x_d /q
respond to all correspondence LING ADDRESS E-MAIL
concerning this application) 00 `3c�kA fh 311 t)) 51"rrc e 4-
CITY h'tri7 I STATE ZIPFAX
w pr S 803 a.
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING M ^
Required value of$5,000 or more �' 1 fra Sctr ce. Gams}-Ind c};dye j'G 0 OWNER-FINANCED
NA
(RCW 19.27.095) � STATE,ZIP
PHONElao0 ( ooADDRESS, Vj ) std. `lvia Glen Ellyn , ;30, Gl& 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 arty 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/ .401
PRINT NAME: S 41tArC /19h n sin
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application