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•...- City of Federal Way (3. M' UrO /5
CITY OF III City
First Way South 411/
• _ Feder:cl Way, WA 98003
_____------ F--- ...rKFR._ - (206)661-4000
APPLICATION FOR MECHANICAL PERMIT
PARCEL ht. ( ' 271G Single Family- Multi-Family 0 Commercial 0
SITE LOCATION: L! `
Tenant/Owner: 'Ej�-��\r� '� eA k i--r- Phone:
Address/City/State2ip: —2-)OH rq ` V `J AI
Nature of work: r I,L )t>(( Fialr)(t- ( blir / Project Valuation: $ 16 15 ,
APPLICANT: N
""( �, i�Name: 1 eRA/0-
-
Address/City/St/Zip: ft2., (c- a� �� �-' J _,> 9B./ .
Contact Person: 6 O�r— Phone: 7:2 Y I Y l Fax: 3 $/ L 47
MECHANICAL CONTRACTfO�iR:(� , f
Company Name: Ak' " "" � 4 c,K
Address/City/St/Zip: �� +�
Contact Person: (t( '\« v, Phone: 2 [ vQ) Fax:
State L & I Contractor Registration #: ""tritikktiL! IL-2-- _ Exp. Date:
(Card must be presented;
MECHANICAL UNIT COUNT:
Fuel Type (gas/other) Gas Dryer r Air Handling < = 10,000cfm _ Fuel Tank
Length of gas piping Range Air Handling > = 10,000cfm Above Ground
Furn <100K BTU's Gas Log Unit Heater Underground
Furn >100K BTU's ins Boiler BTU/H Miscellaneous
Gas Hwt ( Mood Boiler BTU/H Other
Cony Burner Duct Work A/C TONS Other
_BBQ's Wood Stoves i TONS Tnta1 L+ t ,
/
DISCLAIMER: I certify under penalty • • y that ormat.n1, 'shed by m,s -and correct to the hest of my knowledge and further that I ern authorized by the owner of the above
premises to perform the work for ch•-l►r rt !cation is m e. further agr-- o v.harmless the(b' :.radars(Way es to any claim(including costs,expenses and attorneys'fees
incurred in investigation and def -of •r,/•ilk,
1,which may made by any ra , ncluding the urdeiev sd,and filed against the City of Federay Way but only where such daim arises
out of the reliance of the City,in • iters and amplo M,upo- a• • f the information supplied to the City as a port of this application.
rrtiI.
i -- 20
Owner/Ag •nt: -;:it Date: