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. City of Federal Way • RECEIVED CITY OF 33530 First Way South `
• _ F Federal Way, WA 98003
GL� (206)661-4000 AUG 2 51984
WAY AJF
APPLICATION FOR MECHANICAL PERM/TUILDING DEPT AY
PARCEL #• Z? Co 3`")0l 3 ` Single Family Q Multi-Family 0 Commercial 0
SITE LOCATION:
Tenant/Owner: i'\) .in/6— Phone: 838-'- /833
Address/City/State/Zip: cS1717( / 144 Pe- S- -FILE-eI L k)4 y 9c oo3
Nature of work: /%--4S P/p/ (, Project Valuation: $
APPLICANT:
"' / /a 3 �
Name: --'��i �/iGL S /
Address/City/St/Zip:
Contact Person: Phone: Fax:
MECHANICAL CONTRACTOR: J
Company Name: •• 7 — l LL WEA - S.. f!oocJivG-
Address/City/St/Zip: /76,3 S C6-ArL 16,c '7 , t J . 9 70 'L
Contact Person: -7-2Ar'gR,AlJS Phone: 3:3-L/ -- `14L1H Fax: '3-C-4 `lygi5
State L & I Contractor Registration #: 44 ---1-/-11.-1C--0-1-)0(C) Exp. Date:6/ (/ 9'
(card must be presented)
MECHANICAL UNIT COUNT:
Fuel Type (gas/other)N 4-r' Gas Dryer f 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 Miscellaneous
Gas Hwt / Hood Boiler BTU/H Other
Cony Burner Duct Work A/C TONS Other
BBQ's Wood Stoves A/C TONS <7i:; »>f`::> » ri p; :6:6:>.. : > ><<><z>
tsl f}nf Cotfn�
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true and correct to the best 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 City of Federal Way as to any claim(including costs,expenses and attorneys'fees
incurred in investigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the City of Federay Way but only where such claim arises
out of the reliance of the City,including its officers and employees,upon the accuracy of the information supplied to the City es a part of this application.
l C�Owner/Agent: iV °- -I- az Date: 8 —1--c—— /