12-105265 a1 10Mechanical
City of Federal Way
Community&Econ.Dev.Services ,, Permit #: 12-105265-00-M E
33325 8th Ave S
Federal Way,WA 98003 Inspection Re uest Line: 253 835-3050
Ph:(253)835-2607 Fax:(253)835-2609 P q
Project Name: KOLTENBAH
Project Address: 29815 8TH PL S Parcel Number: 515160 0105
Project Description: Relocate gas meter
Owner Applicant Contractor
NJAMIN KOLTENBAH INFRASOURCE CONSTRUCTION LLC INFRASOURCE CONSTRUCTION LLC
29815 8TH PL S 1200 ROOSEVELT RD SUITE 400 INFRACL899CZ(2/14/13)
FEDERAL WAY WA KENT WA 98032 1200 ROOSEVELT RD SUITE 400
98003 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, May 18, 2013
Permit Issued on Monday, November 19, 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 be in accordance ith the laws, rules and regulations of the State of Washington
-- d ,�L C'ty Federal Way.
Owner oragent:
/ Date:
9` '1 AV
THIS CARD IS TO REMAIN ON-SITE
CITY Federal Way°F Construction Infection Record
INSPECTION REQ S: (253)835-3050
PERMIT#: 12-105265-00-ME Address: 29815 8TH PL S
Project: NJAMIN KOLTENBAH FEDERAL WAY, WA 98003-3745
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) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date . 'By Date ‘1_Zo_ `. By a \,4.4., Date )1_ `\
0 Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF A
-I RECEIVE Z - LQ �2&i
PERMIT • MF CO PL PL DE EN FP
Federal Way
COMMUNITY DEVELOPMENT SERVICENO V 19APPLICATION
253-835-2607•FAX 253-835-2609 Y
wroa,.cif iolfrdernfmnj_nni
aet 9
CITY OF FEDERAL WAY
SITE ADDRESS CDS SUITE/UNIT#
02 `'1 S l s� r 1- IVCArce S
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ I , 000 c,v 5 I 5 l (a O _ O c a S
TYPE OF PERMIT
0 BUILDING 0 PLUMBING �q/MECHANICAL
0 DEMOLITION 0 ENGINEERING /❑FIRE PREVENTION
NAME OF PROJECT I � �( l�fk-
(Tenant Name/Homeowner Last Name) - (�
PROJECT DESCRIPTION R C- L oc4- TsC3A-/ of--6 RJ Mit/
Detailed description of work to
be included on this permit only
,
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING C7 ?BVis er ID k a-c S E-MAIL
Cof P-A-1 I A-I STW 4 ZIP
NAME /'1/P/ ZOCn e 41 PHO yLS'--`-57 - vim
MAILING AD REBS�j/�' E-MAIL
CONTRACTOR / O /4 /* Q �,t/ y i 1''
CITY e STATE 4 ZIP ,8/33
FAXa 5 6.5._
, aJit /
WA STATE
CONTRACTOR'SLICENSF ` EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
�/ F��L i �/ 2,AMEN / PQ -/ y X , Itz. /6 --�f -/ lee
MAILIESS
APPLICANT /E Iso S u s /,A x, EMAIL
CITY � STAT$t (`a ZIP /�g/33 FAX
PROJECT CONTACT NAME ,w` , PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) 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 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 r lance of t - city, including its officers and employees, upon the accuracy of the
information supplied to t • ty as a part o t applicatio '
SIGNATURE: d AL _ _./, • DATE
//� / r—/2
PRINT NAME: V EME . a` '
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application