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City of Federal Way
CITY OF ,— 33530 First Way South
• Federal Way, WA 98003 3L(� U -OCo O(
(206)661-4000 tt�/ It `-�
WAY
APPLICATION FOR MECHANICAL PERMIT
PARCEL it. Single Family Vi Multi-Family 0 Commercial 0
SITE LOCATION:
Tenant/Owner: ff',C- el L''9 [j C,0Qp Phone:
Address/City/State/Zip: .Fo/a S w74
?YO Si- F-7-) t1 orf
Nature of work: ti/lel111NJ Project Valuation: $
APPLICANT:
Name: (pa S 7/c /-11,? /--/4,7
Address/City/St/Zip: _1?6?,2 5- r�5 (A �/ So /-rte!) LA-../ -t� 9P°0
Contact Person: c474-: Phone: '6( 2/ 7 9 Fax: a/- 57 6 3
MECHANICAL CONTRACTOR:
Company Name: C96\12---
Address/City/St/Zip: �)
Contact Person: ,�," Phone: Fax:
State L & I Contractor Registration #: 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 Miscellaneous
Gas Hwt Hood Boiler BTU/H Other
Cony Burner Duct Work A/C TONS Other
B
B 's Q
Woodo
SL vee
A/C
TONS <7btstf?nit>eiiici"t:»»»»` > > > < <>>
DISCLAIMER: 1 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 r it 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 such claim),which ma ade 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,includi its flews and empl yeas upon t *cc acy of the information supplied to the City as a part of this application. 1
Owner/Agent: -e Date: � y'y