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(74z-1 ( /74-1' Single Family Multi-Family 0 Commercial 0 SITE LOCATION: Cark)Tenant/Owner: L ' s-fCD-► Phone: Address/City/State/Zip: /31()7 / I�`t S k ` Nature of work: W STe(f r-inZC_--(:-.7- Project Valuation: $ /1 561 APPLICANT: / Name: //�/ V V PGf ml`f • Z?oz- =- //1aiswi lo( S C)W� ( Address/City/St/Zip: r `6' Contact Person: C�7:5'-='r:?:- 401,(14_ Phone: 6 t vf' Fax: z'1 4-12 J ;`"' MECHANICAL CONTRACTOR:� / /� Company Name: ( " t' " d lic.--2:17-6,-- Address/City/St/Zip: OO --Crtuo\to ciC(✓ w ( Wi--- .cf7// 1 Contact Person: I/` -1/ L5-1"- '11 Phone: ZZ 41-1.-00 Fax: State L & I Contractor Registration #: NQZ-1- V V rt`U / Z- — Exp. Date: (Card must be presented) MECHANICAL UNIT COUNT: Fuel Type (gas/other) L/ 'V ? Gas Dryer Air Handling < = 10,000cfm Fuel Tanks: Length of gas piping Range Air Handling > = 10,000cfm Above Ground Furn <100K BTU's l Gas Log Unit Heater Underground Furn >100K BTU's Fans Boiler BTU/H Miscellaneous Gas Hwt Hood Boiler BTU/H Other Cony Burner Duct Work A/C TONS Other BBQ's WoodStov. P s N l`t3tat .)nt Count DISCLAIMER: I certify under penalty of perjury that the information furnished b me is true nd correct t• •-•t of my knowledge and further that I am authorized by the owner of the above premises to perform the work for which permi` pn is made. I further •res to say- armless of Federal Way as to any claim(including costs,expenses and attorneys fees incurred in investigation and defense of w.a(�jc y m e b any person,' cluding :-signed,and filed against the City of Federay Way but only where such claim Vises out of the reliance of the City,including i rr/III•f i- mployees, on -act:ura• •f the inf• • applied to the City as a part of this application. Owner/Agent: V,n ..- Date: rmay/