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CITY oi=--- 33530 First Way South
Federal Way, WA 98003
k--- (206)661-4000
APPLICATION FOR MECHANICAL PERMIT
PARCEL,* CD IfD Single Family 0 Multi -Family 0 Commercial`s
SITE LOCATION:
Tenant/Owner: tl� AL,S Phone:
Address/City/State/Zip: -3 _ i (4
Nature of work:
i ltc _ ~c Project Valuation: $ / 6Oct
APPLICANT:
Name: t� ��_ Y
Address/City/St/Zip: =7"`7 i 7 i . C)/ 7- 51)
Contact Person: 0LL = Phone: � 76� ' � � Fax:7 ` � 7
MECHANICAL CONTRACTOR: q
Company Name: _ A !+c o l
Address/City/St/Zip:
Contact Person: Phone: Fax:
State L & I Contractor Registration #: Exp. Date:
(Card must be presented)
MECHANICAL UNIT COUNT:
C� i ( � t � m
Fuel Typ® (gas/other) Gas D er 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 Hood Boiler BTU/H Other U Ate PIEFu5j P--.
Conv Burner Duct Work A/C TONS Other A-3 Q • 61f-tL%_IE5
TONS
DISCLAIMER: I certify under penalty of PeriW that the Informadon fu nAshwd by me to true Nd correct to the beat of my knowledge and furthw that I am authorizod by the cwry r of the above =.
premises to perform the work for which permit application Is made- I further same to save harmless the City of Federal Way a to arty claim Gncludkp costs, a nti aattornays' fans
ec ,..
lr Trod in investigation anti deferwe of Kith c alml, which may be made by any peraort, "ss'� fVs ud'uIMor*W ,. and filed paint time City �of Faderay Way but ady whore such claim arises
out of the reliance of the City, keduding Its offhc s anti amploye,es, upon the aearaey of the Ixtf Or supplied to the City a a part of this appGeatl n.
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Date-
Owner/Agent: