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City of Federal Way
CITY OF G 33530 First Way South lLD %L.Qqz ci
• _ Federal Way, WA 98003 elEiDERFIL_ (206)661-4000
WFM#
APPLICATION FOR MECHANICAL PERMIT
PARCEL I' Og 1 1 ' [ '-)' Single Family o Multi-Family o Commercia)"
SITE LOCATION:
?�
Tenant/Owner: vrc t✓ 2- c 3 01 i1'i4 7 " Phone:
4 246 y53'3/
Address/City/State/Zip: 2030 640 1J7h 3/ P 01' or - 6•a45 [slit fea)3
Nature of work: -f,~'- '> t/Ot/0r14rsad5 Project Valuation: $
APPLICANT:
Name: r t7 i 13i1/I45 2Ad'v -
Address/City/St/Zip: f�Y�l� 6Y7 Ste �f �-�- 9 tZ?z.
/
Contact Person: �Gf. f"r L Phone: 'Ng -2741f Fax: ' ' WY &6Z
MECHANICAL CONTRACTOR:
Company Name:
* t'7fG C/r2% s 22t.4vLs • '
Address/City/St/Zip: 5i40
Contact Person: Phone: Fax: ��
State L & I Contractor Registration #: .0/�G!F'S <l 7 g 7 Exp. Date: 1 �Z+
(Card must be presented)
MECHANICAL UNIT COUNT:
Fuel Type (gas/other) 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 Hood £4 . Boiler BTU/H Other
Cony Burner Duct Work A/C TONS Other
•
RRQ's Wood Stove. A/C TONS
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true and correct to the but of my knowledge and further that I am authorized by the owner of the above
premises to perform the work for which permit application is made. I further agree to save harmless the City of Federal Way as to any claim(including cuts.expenses and attorneys'feu
incurred in investigation and defense of such daim),which may be made by any person,including the undersigned,and filed against the City of Federay Way but only where such dalm dime
out of the reliance of the City, officers end employees •• the accuri of the information supplied to the City as a part of this application.
gent: _ -- f. fd
Owner �� �I _ Date: