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• City of Federal Way
CITY OF ,r 33530 First Way South
• _ ��� Federal Way, WA 98003 6LN(4-0Le5
WRY (206)661-4000
APPLICATION FOR MECHANICAL PERMIT
PARCEL ff• `), l I -) a Single Family o. Multi-Family ❑ Commercial ❑
SITE LOCATION:
Imo{
Tenant/Owner: (3 e 1 1` L 1l kk-,--\-- Phone: F? q— / g'73i2()
Address/City/State/Zip: gO 34 5 / T� --CrFe V f..,�/ / `"
Nature of work: Pry�'� ' 4-- -7 ( tG Project Valuation: $
APPLICANT: /
Name: PU y G,lJ t�i. /"i
5 fP(. A) C
Address/City/St/Zip: PGS /30.4 c,5--- Plrc y ti //4/9 //45'4 •. "'S 7 1
Contact Person: O`r 1'' ✓ M Phone: W 0- — /`� 9 Fax:
MECHANICAL CONTRACTOR:
Company Name: P 4 /14pp (-`S /9p P6 T AI C-
Address/City/St/Zip. 6' dJ
Contact Person: Phone: Fax:
State L & I Contractor Registration #: .: "fy 4 / C�� d.�c A / Exp. Date: c� JS
(Card must be presented)
MECHANICAL UNIT COUNT:
Fuel Typegas ther) Gas Dryer / Air Handling < = 10,000cfm Fuel Tanks:
Length of gas piping (2' Range Air Handling > = 10,000cfm Above Ground
Furn <100K BTU's 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
BBO
s Wood Stoves A/C TONS "E ttf`{J`rft'i✓oz t ;;Ezii; ;.;; „
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true and 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 application is made. I further agree to save harmless the Cityiof Federal Way as to any claim(including costs,expenses and attorneys'fees
incurred in investigation and defense ofsuch claim),which may be made by any person,including the undeisigned,and filed against the City of Federay Way but only where such claim arises
out of the reliance of the City,irScluding its officers and employees,upon the accuracy of the information supplied to the City as a part of this application.
Owner/Agent: Z -` Date: