1989, 01-04 Permit App: 89000040 Furnace, Piping/5-072
MECHANICAL PERMIT APPLICATION WORKSHEET 9 u"
PLEASE PRINT AND COMPLETE. ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND-
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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-
plled 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
OWNER OR
APPLICATION 4, v Jsy
• DATE
Project I
Owner's Name Last2ciALir First - MI
.
Project Address (Street Name & Number " , n _ ie -el
City (`!�`
Stets �� -
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Aasesaae Portal I ����3 ' 01 / 5
Lot
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Block
Plat I
Applicant
Address
City
1 State
Zip
Phone
Business Phone '
Contractor HEAT i IAB$FER, MC.
N.1008 RUBY
Address
City SPOKANE, WA2
(509)328-3400
Zip
Phone
Contact
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Business Phone
Describe Work / / Sos 0 d gr U :46/
Fans
Evaporative Cooler
Hoods U
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Hlr.
Solid Fuel/ Wood Stove
Air Handling Unite
0-10,000 CFM
10,000+ CFM
ReIrl0eratlon Systems/
Heel Pumps (BTU)
t -100M
'
101-500M
501-1,000M
1,001.1750M
Over 1750M
Compressor
0-3HP
3-/5HP
15-OOHP
3O-50HP
50+HP
Gas Piping
t-5 Outlets
a+Outlets /
Gas Fired Heating System
1.1c0,000BTU
�p G G Q
lOuA00+BTU
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-
plled 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
OWNER OR
APPLICATION 4, v Jsy
• DATE