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City of Federal Way
CITY OF At -- 33530 First Way South
® Federal Way, WA 98003 '
1--, ---cniar,...<Firt_ (206)661-4000
VieW , 5- Oa 13
APPLICATION FOR MECHANICAL PERMIT
PARCEL • 7 3 Z 13 1 Z I �° Single Famil :'"" '"1 T
g y Multi-Family 0 Commercial 0
2 3 199
SITE LOCATION:
Tenant/Owner: ( � !' 1 `C.LI C Gr c ` - ���V
Address/City/State/I 11'p: 9 (. St. fa--Q--
(� rN w�- -- �L e C-C_L] — —
Nature of work: 3N Project Valuation: $ `���
14)._12.“5-e- rYN.eA. -- /k-7 01 kA-P.-k1a—ei -J
APPLICANT:
Name: �lA-VV\ta_ �a Id2--0,o✓"
Address/City/St/Zip:
Contact Person: Phone: Fax:
MECHANICAL CONTRACTOR:
Company Name: ^ w r ` CA ep....._____
Address/City/St/Zip: 'Z'aa0 I/'\M if\ V, c , ( l '7
Contact Person: n(s- Phone: 2-8-2 1 J W Fax: 3 9 `I 9---
State L & I Contractor Registration #: / 1 h1T L)/4' w(.3 t 2- Exp. Date: te/53---
(Card must be presented)
•
VIECHANICAL UNIT COUNT:
Fuel Type .ther) Gas Dryer Air Handling < = 10,000cfm • Fuel Tanks:
Length of gas piping Range Air Handling > = 10,000cfm Above Ground
Furn <100K BTU's Gas Log Unit Heater Underground
Furn >100K BTU's Fans Boiler BTU/H Miscellaneous
Gas Hwt ( 1 ) Hood Boiler BTU/H Other
:onv Burner �� Duct Work A/C TONS . Other
)BQ's Wood Stoves A/C TONS • . laiiMiiiragilarvaaag
CLAIMER: I certify under penalty of perjury that the information furnished by me is true end correct to the best of my knowledge and further that I am authorized by the owner of the above
Hues to perform the work for which permit application Is made. I further agree to save harmless the City of Federal Way es to any claim(Including costs,expenses and.attorneys'fees
tred in investigation and defense of such claim!,which may be made by any person,including the undersigned,and filed against the City of Federay Way but only where such claim arises
of the reliance of the City,including its officers end a pf ees, the accuracy of ae ation supplied to the City es a part of this application. _
vner/Agent: Date: � /' (( V
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