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• • City of Federal Way •
_
CITY OF f N_ I/- I 33530 First Way South WC(- cs13O
�� ``►F_ Federal Way, 98003
(206)661-4-4 000
. >/ elf:r
APPLICATION FOR MECHANICAL PERMIT
PARCEL #• '..-F---3 I 'U O 2^3 n Single Family Multi-Family 0 Commercial 0
SITE LOCATION: s�2 , �-�
Tenant/Owner: C C='Y�' t.'/
C C Phone:
Address/City/State/Zip: -c0 4( v '�V 3( 5
Nature of work: (I('s1 (6:".)/ 1 rel °`S 10// b-C Project Valuation: $% , 1°2'
APPLICANT: ,/�
/�
Name: / l/�" P11(111-f-
•
n 6Z hu O (' f G/ v
Address/City/St/Zip: 2� /. �/
Contact Person: 'crirfa w Id Phone: /ZL 0 ` ot 1 Fax:
MECHANICAL CONTRACTOR:
Company Name: / v (Al (Al Lt51-d6-7-fi--- —
Address/City/St/Zip: I'S/06 x(41 i YLE kI Wig gIti
Contact Person: ( c ' `►Li--( Phone: 1?177__f C ° Fax:
State L & I Contractor Registration #: 01 l i
✓v Wild t' "z-- Exp, Date:
(Card must be presented)
MECHANICAL UNIT COUNT:
Fuel Type (gas/other) C—f 1 Gas Dryer Air Handling < = 10,000cfm Fuel Tanks:
Length of gas piping 'd Range I Air Handling > = 10,000cfm Above Ground
Furn <100K BTU's Gas Log If )- Unit Heater
/oegar‘AUnderground
Furn >100K BTU's Fans Boiler BTU/H Miscellaneous
Gas Hwt Hood Boiler BTU/H Other
Cony Burner Duct Work A/C TONS Other
B84's
Stove.
W od s
o
N >`1'ftaf`#J of Cottnt
DISCLAIMER: I certify under penalty of perjury that the information furnished by m tr and correctly!,- best of my knowledge and further that I am authorized by the owner of the above
premises to perform the work for which pe�r.•- ppt n is . I f ther agr to sae harmless •ty of Federal Way as to any claim(including costs,expenses and attorneys•fees
incurred in investigation and defense of.. "' 0 may be m by a• perso including . •ersigned,and filed against the City of Federay Way but only whore such claim arises
out of the reliance of the City,includi •fic / •employees,up n t ■cc�% of the in • ti•. supplied to the City as a part of this application.
Owner/Agent: / / Date:
2—Y/ Ct `f