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V. r::3'% 'tf % , Name Address City State I Zip Contractor Name Address City State Zip Contact Phone Fax License# Expiration Date Verified 0 Yes 0 No f/fi. Sv"{,Div%r/�vr{lfi:f' '%% .y�I:yr rrf r Contractor Name Address t City State Zip Contact Phone Fax st License# Expiration Date Verified 0 Yes 0 No 1{`',lrfy'' r,'{"j. f�-. y,y'��%.'u'j j;( �f"-�1 {irc'�fJ%fl %/'Ji%//r: I+ Water Closets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps RM Lavatories Washing Machine Drains '1. ip1; A: pj # ;; :r<„f . r 8.;' ?' r% r r r %%;%%fir' MECHANICAL EVALUATION ONLY 8 Fuel Type(electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons Furn <100K BTUs Gas Log Unit Heater 50+ Tons Furn >100 BTUs Fans Miscellaneous Fuel Tanks Gas Hwt Hood Boilers Above Ground Cony Burner Duct Work 0-3 Tons Underground BBQ' ,: s Wood Stoves 3-15 Tons z'1'+Yt#I#��t :� •.`•.< :>':>�<f�<?%>.;.•;s:.;: DISCLAIMER:I certify undo penalty of perjury that the information furnished by me is true and correct to the bed 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 costs,expenses,and attorneys'fees incurred in' 'on and defense of su ),which may be made by any person,including the undersigned, and filed against the City of Federal Way,but only where such claim arises of the tel of the city,' employees,upon the accuracy of the information supplied to the city as a 9/1/91 art of this application. 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