11-101856 •City of Federal Way . Mechanical
mit #: 11 -101856-00-SNI E
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: POLAND (CRESTWOOD MHP SPACE 183)
Project Address: 1645 S 272ND ST Space 183 Parcel Number: 332204 9010
Project Description: Relocation of gas meter w/gas line extension.
Owner Applicant Contractor
CRESTWOOD MOBILE HOME PARK INFRASOURCE CONSTRUCTION LLC INFRASOURCE CONSTRUCTION LLC
1645 S 272ND ST 3380 146TH PL SE#310 INFRACL899CZ(2/14/13)
FEDERAL WAY WA 98032 BELLEVUE WA 98007 3380 146TH PL SE#310
BELLEVUE WA 98007
Additional Fie it InformatioCl' ...,�'� ,,..•�. f
Mechanical Valuation 1000 Is this an Online or O.T.C.applications Yes
Mechanical Fixtur
Gas Pipe Outlets 1
PERMIT EXPIRES Wednesday, November 9, 2011
Permit Issued on Friday, May 13, 2011
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: --`l.3
FINM( EA so/refit
THIS CARD IS TO REMAIN ON-SITE
CITY OF � `""° - • Construction I> iection Record.
'Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT #: 11-101856-00-ME Address: 1645 S 272ND ST Space 183
Project: CRESTWOOD MOBILE HOME PAR FEDERAL WAY, WA 98032-6835
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.
fl Mechanical Rough-in (4165) El Gas Piping(4125) 0 Final-Mechanical(4065)
Approved Approved to release test ,''.'✓' Approved
By Date By . ,.- Date , / By 4.,;-- Date /3
�
j �1i ,
0 Rough Electrical Final Electrical .� Right of Way
Approved Approved Approved
By Date By Date By Date
�ERMIT l - - '
LDL __ -----1.,
" OTT Qi
Federal Way 5 RE tiv EDN FP
COMMUNITY DEVELOPMENT SERVICES APPLICATION
253-835-2607•FAX 253-835-2609 ��
.,.c,;o ,F;_{1,,a1,�:," MAY 1 3 2C11 7%
SITE ADDRESS CITY
/b 4s- Z7 z ._, Si /93 N 1 (S7 etS5 3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ iroo 3 3 b g - °1 U ( v
TYPE OF PERMIT 111BUILDING CIPLUMBING )MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) 3.--1 /2 je, __ / C e o 7 �� �9 /
PROJECT DESCRIPTION AI A-- 114-/C-EZz-/L'%L ke./d�C/ l(.•�-�c%((//VV���//���//eq,� -s 71ft-..(. -t, e-,(Teilsi `}.�1.�
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER f�//� /f Pd 7 /3 Zs--3 5i/ a9 --�
1 C
MAILING
J R5ESS G-�Z Si- /8 3 E-MAIL
CI STATE ZI p
�=Y�- wa_I G�'a- U0o3
PHONE
Tri (/� IJ/ e,.3/�
MAILING ADDRESS
y� /�� E-MAIL
CONTRACTORWry STATE/ Z U C7 ' C7O- �� 72-10 `Sre /1 FAX
` 6�/`AJ /L CYO/ 3 7 FAX
WA-TSTATE�ON��CTOLR'S('L�IC�(N�SE�� EXPIRATION DATE FEDERAL��Y BT,SI ES ICENSE#
3 A // /C....L D ' / Z 14- /,� 0! — !S�!
----__- ---_- NAMPHONE
E V (.-/LJ 2S3 2-7o Z9> /
APPLICANT MAI NG ADDRESS E-MAIL
CI5 � STATE FAX
i4.4
z
PROJECT CONTACTxnME (,� PHONE
(The individual to receive and V "7p`� �1 Z 3 `3�� �g�/
respond to all correspondence MAIL G ADDRESS E-MAIL
concerning this application) o>1 S Z,72. ' s T'
CITY STATE 2 FAX
T w Ve).0.-. -2.-
ALTERNATE
2.ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
111 OWNER-FINANCED
Required value of$5,000 or more
(RUW 19.27095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the st
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply 'th
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 Iaws regula 'ng
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,.,a part of this application.
J
SIGNATURE:; ,Ale.
1- DATE S —7,5 //
PRINT NAME: & V G /l)t.4066,-
Bulletin#100-January 1,2011 Page 1 of 3 k:AHandouts\Permit Application
S •
,�. ,r Via' e s s
VALUE OF MECHANICAL WORK $ /OOU (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 ) GAS PIPING WOODSTOVES
s , titfiff.44. .a b� - a+8 � �'
._. .. „
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/Shower Combo) LAVS(Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electr(c)
HOSE BIBBS SUMPS WASHING MACHINES ),, ' 4 It�
:61 ;� - ^^' . GE TERA L t :8:11
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑Yes No
RESIDENTIAL - NEW OR ADDITION k "
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASE ai �• � ' •
FIRST FLOOR(or Mobile Home)
."� a== ,•�'° ^fir ��� ,�. ---- -•----------- —_____ _...__... __._...------
COVERED ENTRY
�� s z, k✓ a c �. i
5
IK a
;, �. :- : `_max .. y x
GARAGE ❑ CARPORT D
OTHER des
w„
EXISTING PROPOSED TOTAL
— ...
Area Totals
***NEW HOMES ONLY*"
ESTIMATED SELLING PRICE$ _ # OF BEDROOMS
C()MNIERCIAZ4EW /A 3D1T.IO a..... Ns € F
Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square FeetType
a Stories
'N a,lffi, r
ADDITION
COMMERCIA — REMIODE1JTENAN I11"iPROVE QTS
AREA DESCRIPTION Area . Occupancy Group(s) Construction # of Additional Information
in S.uare FeetStories
s a wry 3. .ate' " 3 .°'s ��"
air es �a +
TENANT AREA ONLY
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application