1985, 08-06 Permit App: 00007092 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) - (First) (M)
5--'--4(... u. A
Department Use Only
Project No. ' / 0 L.2.-
2 Project Address (Not Mailing dress) Space Zlp
/3 to (e - 43—a -4_4 j, 7,(1-0 G
3 City/Comm
Stae,Subdivision/Plat
(.•
Name
4 Avamsor,Parcel .
P
CFirm
Lot
Block
16 Conic tor Name /�
C0 to1.
--�1�l ti, l A i
Str Address ./p
?a // 'Cr -'NM.,--
17 Zip1
Cid-0c�
City
�e_:---n w,
Stets
uJo_
Phone
( ) 9 01-'4)-S .1-
18 Contact Person
License No.
Phone If different than above
wgyL/1iW+/�
8 Owner/Agent
different than 61 above)
Bupjpess
Address
g Zip/ / ° e
City
State
Phone()el
15 Describe Work:
New Addition/Alteration 0
Replace/ Repair 0
10 Applicant Name r
Street
Address
11 Zip
I City
State
Phone
( )
8 VENT: Fan(s):
Evap Cooler(s):
Hood ):
Duct(s)1: '
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I Range s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNITHEATER(S): wail Mount: Y N
Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10,000CFM or less:
More than 10,000CFM:
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. t.):
15 COMPRESSOR/HP: Lusa than 8:
3-15: -
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU:
180,001 + BTU:
��\ ///'''
18 TYPE FUEL SOURCE: Electric Jq ; Gas 0 ; Oil 0 ; Coa 0 ; Wood 0 ; Solar 0
/Forted`
\
19 TYPE DISTRIBUTION: Alr %]l ; Radiant 0 ; Heat Pump
1* Number of separate zones for arty heating, A/C or air handling system.
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, Including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction:
SIGNATURE OF ALDENDORF (FURNACE,
OWNER RE A�VSIONOFALLIED HEATING, INC. APPLICATION
ORE. 9311 TRENT AVE. DATE SAPS
+C:<•SNE, WA 992016
928 292