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Contractor Name � � �141, f � 1D Address 3414A i � �� City �`-YtA State tJA - Zip 9,66 Contact n� ! p Pho Fax J rri�p License # 3-) u Expiration Date �( Verified ❑ Yes ❑ No PLUMBING MTURE COUNT Water Closets `3 Sinks '� Urinals 10Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Showers I Electric Water Heaters Sumps Lavatories 17Washing Machine Drains --TTotal Fixture Count MECHANICAL UJgff 'CUUNT Fuel Type (electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons Length of Gas Piping g77— Range �f Air Handling > = 10,000 CFM 30-50 Tons Furn <100K BTUs Gas Log Unit Heater 50+ Tons Furn > 100 BTUs Fans Miscellaneous Fuel Tanks Gas Hwt ' Hood Boilers Above Ground Conv Burner Duct Work h5"tc,- 0-3 Tons Underground BBQ's AWood Stoves '0 3-15 Tons Total Unit Count 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 Federal Way, but only where such clarm arises out of the reliance of the City, including its officers and employees, upon the accuracy of the information supplied to the City as a part of this application. / . _Date: �-� 31IJ x 4IL- (I w� Y y rY �v 00020 � d�a% = � � NI'd'✓�I 4vi ,c�'oa7 L7 ,� S Aj� I S rq 1 O i O !O 1