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•CITY OF �- 33530 •First Way South
• _ Federal Way, WA 98003
\`\` (206)661-4000
V V
APPLICATION FOR MECHANICAL PERMIT
5 ( 5.20UCS3 o
PARCEL it. Single Fami Multi-Family El Commercial 0
SITE LOCATION: Raz\.\- 1
Tenant/Owner:
V 0 V 1n`�1�� L �\ Phone:
Address/City/State/Zip: 3 02 03 t. ff, W � \N (1g�,
Nature of work: t` �_ rl o ��^ Project Valuation: $ J 2-4/0
APPLICANT: �` \ , t 1
Name: v \ JF , VV` , /��1� V�\Vv '�� . 1 ( It/�L ,
N
Address/City/St/Zip:
Contact Person: Phone: -52-2- ( I ( Fax: '2CI ' c+FZT--q-'
MECHANICAL CONTRACTOR:1 ..,\Ni
V\f r"--- tA_ 1,C. it-----
Company Name: ' � ,,� ,.1�
Address/City/St/Zip: �'`'& .�9��� � �r1' � -.E All '
Contact Person: Phone:2 (2-- Ci-'7
U� Fax:
State L & I Contractor Registration #: q:)fZ kiV v \Tt I Li" , --- -2-- Exp. Date:
(Card must be presented)
MECHANICAL UNIT COUNT:
Fuel Type (gas/other) Gas Dryer Air Handling < = 10,000cfm Fuel Tanks:
Length of gas piping Range Air Handling > = 10,000cfm Above Ground
Furn <100K BTU's Gas Log Unit Heater Underground
Furn >100K BTU's Fans Boiler BTU/H i 7U Miscellaneous
Gas Hwt Hood Boiler BTU/H Other
''"
Cony Burner Duct Work A/C . TONS Other
....................................................................
...................................................................
BBQ's _ Wo_o_d Stovvees TO `:Trioti.riit:;Ciiiifie»i:i:i*>:;>:<»:: i:K:r;»:
DISCLAIMER: I certify under penalty of perjury that •��V,-tio urnished by me is true - • corre t to the best o•m 11. ledge and further that I am authorized by the owner of the above +premises to perform the work for which permit a•• • ade. I further agree to say - armle=t the City of F :er- asto any claim(including costs,expenses and attorneys'fees
incurred in investigation and defense of such cl li, .01T ay be made by any person,' cludi • he undersig .d, / against the City of Federay Way but only where such claim arises
out of the reliance of the City,including its• cars 'ployees,upon the accuracy the i •mat p-ied _ part of this application.
7
(/ f
Owner/Agent: ���11117 /'� Date: Li
IF