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• City of Federal Way •
CITY OF �— 33530 First Way South a
• _ I Federal Way, WA 98003
V V �y (206)661-4000
\`VV
APPLICATION FOR MECHANICAL PERMIT
PARCEL it. og 2 I L' cU Single Family,0- ' Multi-Family 0 Commercial 0
SITE LOCATION:
Tenant/Owner.- '-"- ! A �i ` Phone:
c
Address/City/State/Zip:, ' t CI `.,)-- .'li .,-.1 •' •
Nature of work: 1 - .L A -1d ? lit ' n , J - '� ' •roject Valuation: $s
` /l
APPLICANT:
•
Name: "u �% _ 4 4 —
Address/City/St/Zip: , C - ar C- ‘ 6(1',6'S-
,_,-
1,6
Contact Person:-flit_ A-( ill 6(l) Phone: 3.--- - O i I Fax: L'.06:1- Li?-7-771
MECHANICAL CONTRACTOR:
Company Name: !'IO 0 ( U U`-'6`-1-`r - Wk(
Address/City/St/Zip: -•` l 1 - �` — �- Ci l
Contact Person: r roi Phone:---c �I -I I Fax: CV4-1 77
State L & I Contractor Registration #: MO\11)tLL+I 1(F?4ca_, Exp. Date: 1)
(Card must be presented)
MECHANICAL UNIT COUNT:
.
Fuel Type (gas/other) ( Gas Dryer Air Handling < = 10,000cfm Fuel Tanks:
Length of gas piping 1.)C, 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 0 le-i- /f_t d L /tit .L,
Cony Burner Duct Work A/C TONS Other
BBQ's Wood Stoves A/C TO Iifi ii > tz< iiti 2 > >'
NS al#ant Cott
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 end employees,upon the accuracy of the information supplied to the City ss a part of this application.
Owner/Agent: �� 1),JACtil Date: (4-7.1- ')11
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