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• City of Federal Way IIICITY OF 1 ."-"*.''' 33530 First Way South
• FE:171 -rKFIt-- Federal Way, WA 98003 g� �j�f_O&X
(206)661-4000 �^%J� `� V
�Ry
APPLICATION FOR MECHANICAL PERMIT
Cx='
PARCEL l• o -1 t Single Family Multi Family III Commercial
SITE LOCATION:
Tenant/Owner: �1 C"t pQkp Phone:
Pr
Address/City/State/Zip: C7°l SI:). 2' $
Nature of work: Project Valuation: $
APPLICANT: D
Name: C q -/P He-ei'ft 'j
Address/City/St/Zip: 3 s74
T ( S' (mac 0 ' CJI / C
Contact Person: Phone: J
�L/- �/ 7i Fax: ��/-576-
MECHANICAL CONTRACTOR:
Company Name:
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
BBQ's Wood Stoves
_ A/C TONS
oxttt
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 arty 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 ample.- ••on the occurs, of the information supplied to the City as a part of this application.
�.�. .� Y — 77
Owner/Agent: Date: