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crrYf1P C / BiJIIAINGD1WSI0N
33530 First Way South
E� Federal Way, WA 9" 003
(253) 6614000
Fax (253) 6614129
APPLICATION FOR MECHANICAL PERMIT
MEC
PARCEL At Single `'� Single Family Commercial ❑
SITE LOCATION
Tenant/Owner ' \ Phone r
Address/City/State/Zip
Nature of Work ��-�,U:�� L� Project Valuation:
APPLICANT
Name
Address/City/St/Zip
Contact Person Phone Fax
MECHANICAL CONTRACTOR
Company Name
Address/City/St/Zip 2r�t�ilJ ��� S) � -2L!
Contact Person L a,,? aAJ6-eL-a Phone � Fax
State L & I Contractor Registration # Exp. Date
(Card must be presented)
MECHANICAL UNIT COUNT
Fuel Type ether
Gas Dryer
Air HandliM <= 10 000ef[n
Fuel Tanks-
Len of as i in
Range
Air Handlin > =10 000cfm
Above Ground
Furn <100K BTU's
GasLog
Unit Heater
Under ound
Furn>100KBTUs
Fans
Boiler BTU/H
Miscellaneous
Gas Hwt
Hood
Boiler BTU/H
Other
Cony Burner
Duck Work
A/C TONS
Other
A/C TONS
x k
DISCLAIMER: I certify, under penalty of perjury, that the information funtished by me is hue 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 appliention is made. I further agree to save harmless fie City or Pcdetal Way as to any cl ' ding oa Ls, 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 Pederay Way bu[ aniy t 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.
Owner/Agent
Date
MP.cu APP
Rewsm 8/26/97