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City of Federal Way ciry oF G 33530 First Way South _ � _ Federal Way, WA 98003 - �EIZF-�L_ �Zos,ss,_a000 ��D� ��-a� � ��F-�Y APPL/CA T/ON FOR MECHAN/CAL PERM/T PARCEL�• �����v�� Single Famil Multi-Family o Commercial � SITE LOCATION: Tenant/Owner: � ' ��� S� Phone: Address/City/State/Zip: � 0� S � S � Y � Nature of work: �� S���C v u�i��' �-��' Project Valuation: S S �d� APPLICANT: , Name: ; �"" G����� Address/City/St/Zip: �Q�� j�"���l�`C�'! �U� �� � V�� ���/�v Contact Person: `_� �/��C � Phone: ��� a C�� Fax: -�� ��'� MECHANICAL CONTRACTOR: Company Name: - � v '"" 'v v�!vJ ��--�CY~ Address/City/St2ip: av� ���-��Y����/� �� l�V✓I L�`` / � y�-a � Contact Person: ��� �� Phone:��Z Fax: State L & I Contractor Registration #: T'=L( � �'V�l���-�� Exp. Date: (Card must be presented) MECHANICAL UNIT COUNT: Fuel Type (gas/other) Gas D er Air Handlin < = 10,OOOcfm Fuel Tanks: Length of gas iping Ran e Air Handlin > = 10,OOOcfm Above Ground Furn <t00K BTU's Gas Lo Unit Heater Under round Furn >100K BTU's Fans Boiler BTU/H Miscellaneous Ges Hwt Hood Boiler BTU/H Other Conv Burner Duct Work A/C TONS Other DISCLAIMER: I certify under pe��lty of perjury that the information furniahed me' Gue and corr�ct to the bat of mV�W�edpe�1 furtFar th�t 1�m authorized by tM owner of tM�bove premises to periorm ths wwk for which permit�ppliution is m�de. I furt �ee t s�va Furm t ity of f-�deral W�y r to�ny W�im lineludinp cwb,�xpernu�nd�ttunsri fen ineured in investip�tion aM deferre of• 'ml,w m�y made sny p� on,includi �ipnsd,�nd filed pdnt tM City of fede��y W�y but aNy wFrn weh drm�risw out ot the reli�nee of the Ciry,inel i fi �nd emploY ,up hs�ee �cy of the i ti �uppliad to tM City r�p�rt ef thit applie�tion. Owner/Agent: Date: � �