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