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City of Federal Way
CITY OF G 33530 First Way South g.....0(-_ L—..._
s.—
Federal Way, WA 98003 �2f
V1FrY
(206)661-4000
APPLICATION FOR MECHANICAL PERMIT
•
PARCEL ff. 10 9 9 610 4 0 0-0 2 Single Family b Multi-Family o • Commercial 0
SITE LOCATION:
Tenant/Owner: Don Kelly Phone: 815-16 2-
Address/City/State/Zip: 3733 SW 335th Ct Federal Way, 98023
Install furnace, water heater and piping 4600
Nature of work: Project Valuation: $
•
APPLICANT:
Buffy Grow
Name:
2802 E Madison Seattle 98112
Address/City/St/Zip:
322-8191 631-6859
Contact Person: Phone: Fax:
MECHANICAL CONTRACTOR:
Company Name: NW Water hPafF+r
Address/City/St/Zip: 2800 Thorndyke Seattle 98119
Contact Person: Phone: 2 8 2-4 7 0 0 Fax:
NORTHWH103R2 12/22/94
State L. & I Contractor Registration //: Exp. Date:
(Card must be presented)
MECHANICAL UNIT COUNT:
•
Fuel Type (gas/other) G Gas Dryer Air Handling < = 10,000cfm • Fuel Tanks:
Length of gas piping 95 Range Air Handling > = 10,000cfm ._Above Ground
Furn <100K BTU's 1 Gas Log Unit Heater Underground
Furn >100K BTU's Fans Boiler BTU/H Miscellaneous
Gas Hwt 1 Hood Boiler BTU/H Other
Cony Burner Duct Work A/C TONS Other
BBQ's Wood Stoves A/C TONS • .. ..i..,.s`.
DISCLAIMER: 1 certify under penalty of perjury that the information furnished by me is true end correct to the beat of my knowledge and further that I am authorized by the owner of the above
premises to perform the work for which permit applicedon is mode. I further agree to sew harmless the City of Federal Way as to any claim(Including coats,expenses and attorneys'fees
incurred in investigation and defense of such daiml.which may be made by any person.inducting the undersigned.and filed against the City of Federay Way but only where such claim arises
out of the reliance of the C its officers andf,yMYofInfonnedon
supplied to the City as a part of this application.
Owner/Agent: Date: I
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