10-104761City of Federal Way
Community Development Services
P O. Box 9718
Federal Way, WA 98063-9718
Ph: {2 31 835-2607 Fax: 1253] 835-2609
Project Name: CAMELOT SQUARE LOT 24
Project Address: 3001 S 288TH ST Space 24
Mechanical
Permit #: 10 -104761 -00 -ME
Inspection Request Line: (253) 835-3050
Parcel Number: 042104 9155
Project Description: Gas fuel line extension
Applicant Contractor
weerPILCHUCK CONTRACTORS INC
CAMELOT SQUARE INC PILCHLICK CONTRACTORS INC PO BOX 2579 pILCHCI101MA (02/20/11) 3001 S 288TH ST KIRKLAND WA 98083 p0 BOX 2579
FEDERAL WAY WA 98003 KIRKLAND WA 98083
Additional Permit Information
Mechanical Valuation............................................1000
Is this an Online or O.T.C. application?-_.... ... ........ Yes
Mechanical Fixtures
GasPipe Outlets ............................. 1
PERMIT EXPIRES Sunday, May 8, 2011
Permit Issued on Tuesday, November 9, 2010
I hereby certify that the above information is correctwith thte lawsthe
rues andlregulat ons of the Stat o Wash ngton on on the above described property d
the occupancy and the use will be in accordance4&1 K�- and the City of Federal Way.
g
Date. // J r Lp
Owner or agent:
CITY OF
Federal Way
aJlu x—ME%1! 10 1 V tti.fi JVIAJUN
Construction Ins,action Record
INSPECTION REQUE�TS: (253) 835-3050
PERMIT #: 10 -104761 -00 -ME Address: 3001 S 288TH ST Space 24
Project: CAMELOT SQUARE INC FEDERAL WAY, WA 98003
Scheduled inspections may be failed irthis card is not on-site. DO NQT LOSE 't Il qRD. Inspections arc fisted as cause to sequential order as
passible (read 10 to right, top 1p bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your
inspector if you tire unsure about any of the inspections or the inspection sequence. Ori -going inspections are fogged on tfte back of this card.
E] Mechanical Rough -in ( 165) 1 [:] as Piping (4125) r]Final - Mechanical (4065
Approved Approved to release test Approved
BY Date By Date By� Date � 7�$
Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date
BY Date
f � r�al Way
r:rh4Thll.ud�tY n�IFi.u2:ri5,?'8 s2ew� �
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SITE ADDRESS
Sap 1 S 2 -es
PROJECT VALUATION
$ /000
TypE OF PERMIT
ATAB OF pROJECT
(inrnen,uner Last Name)
fTop rri Name
PRO.3ECT DF
5CRiPTION
I]etailetd description of work to
i?e inel"ded an this per+ni! only
PROPERTY OWNER
NTRACTOR
A PpLICANT
PERMIT
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❑ BUILDING ❑ PLUMBING FIRE PFtEVENTION
❑ DEMOLITION ❑ ENGINFFP_1NG
❑
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PRCONTACT
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PRa.FECT FINANCING
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E,IRATION DATE
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r{Prluir-ed value of $5, 000 O'more SLING ADDRE
(RCW 2 4.27-095] f the grape owner. I certify that to the best
cat o ! with
that I will comp y
owner or authorized a5 a permit. I understand that the
u that I am the propert�j lication is true and cor+ect• I certify relating
underpena[ty of pert r'J "t of this permit app federal [arvs reg
I certify the Penalty
,.matiorz submitted [n sxp atning to the ruerk ttntharixedalrtcc with lata[, state, or,
of my knowledge+, utations part res onsibility for consp
s' Fees incurred n
licable City of Federal Way reg the owner's p eases and attorney f mast the city,
all app permit does not removectatm {including costs, �P and filed ag
of this p as to any the undersigned, the accuracy of the
issxancrt enter! [aws. o Fed€rat Wag er'e" including re on
any P f Cers and cmP[oycas, P
construction or environm wizich may be made irzctuding its o 13
,further agree to hold harmless thctaim of the city,
such claim Krises out of the reltartea
the investigation and def, of such 'this app but army where as a part of , I %
tr4formatlon supP[led to the the c/i/tfy} DATE
k,\14,nd0utslper,nil Application
SIGNA'
PRINT NAME:
_.:I 1& 2010
page 1 of 3
Bulletin #100 — April 14, 2010
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