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1986, 11-04 Permit App: 00013993 BoilerMECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 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 APPLICATION OWNER OR DATE Project # J3QQ3 Owner's Name Last First MI DIXON RICHARD L Project Address (Street Name & Number) 13203 E FO ST City State SPOKANE WA Subd ision/Plat Name �ResT ACkVas 3o Assessors Parcel#J44 _ /6 5 Lot Block P23 / # /C 2 Applicant GOLD SEAL MECHANICAL. INC Address 5524 E BOONE City SPOKANE State WA Zip 99216 Phone 535 5944 Business Phone Contractor SAME Address City State Zip Phone Contact R. DIXON License # GO LD SM 290 C4 Business Phone Describe Work REPLACE ELECTRIC BOILER W/GAS BOILER Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous Dryer Range Gas Log ' Gas Water Htr. Solid Fuel/Wood Stove Air Handling Units 0-10,000 CFM 10,000+ CFM Refrigeration Systems/ Heat Pumps (BTU) 1-100M 101-500M 501-1,000M 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP Gas Piping 1-5 Outlets 6+ Outlets Gas Fired Heating System BOILER 1-100,0008TU 10,;,00+BTU 140,000 BTU INPUT VAILANT ift•�/ 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 APPLICATION OWNER OR DATE