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PARCEL #
flecever-)
SOV Z 21999
RAL
GIT GILDING DEPTVpY
APPLICATION FOR MECHANICAL PERMIT
Federal Way Business License number:
SITE LOCATION
BunDiNG DmsloN
33530 First Way South
Federal Way, WA 98003
(253) 6614000
Fax (253) 6614129
MEC 9q -
Single Family ' Multi -Family ❑ Commercial ❑
Tenant/Owner Phone
Address/City/State/Zip GI • � CC
Nature of Work Yn Project Valuation: $
APPLICANT
Name
Address/City/St/Zip
Contact Person L,c,:'� G ►1 ►'1%1 d< .� t� ccX ��' Phone C � f> V2 `--\-Fax
MECHANICAL CONTRACTOR
Company Name (A/
Address/City/St/Zip ' L J D�" '
Contact Person Phone 200 YL -A7�00 Fax
State L & I Contractor Registration #
(Card must be presented)
MECHANICAL UNIT COUNT
WAsHies( qq (n
Exp. Date 6 /01
Fuel other
Gas Dryer
Air Handling < = 10 000cfm
Fuel Tanks:
L,ength of gas pipingRange
Air Handlin > = 10 000cfm
Above Ground
Funn <100K BTUs
Gas Log
Unit Heater
Underground
Furn >100K BTUs
Fans
Boiler BTU/H
Miscellaneous
Gas Hwt
Hood
Boiler BTU/H
Other
Conv Burner
Dud Work
A/C TONS
Other
Wood Staves
A/C TONS
DISCLAIMER: I om*, under penalty of perjury, dual are cdormation arnislmed by me is true and correct to the best of my imowdpdge and fiuther that 1 am authorirsd by the owner of the above pranisscs to perform the work
for which permit application is made. I firdw agree to save harmless the City of Federal Way as to any claun (mchkbns costs, expenses, and attorneys' fees insured in investigation and defense of such claim). which may be
made by any person, inchdmg the undersigned, and tiled against the City of Federay Way but only where such claim arises out of the reliance of the city, inchding its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
Owner/Agent
MOCK A"
Date
1 1 ( 3a L