1986, 04-23 Permit App: 00010756 Heat PumpMECHANICAL 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 0R DATE `�"
Project# !V li.,ifJ
Owner's Name
Last
Jordan
First
Beverly
MI
(�
Project Address (Street Name & Number)
N. 4712
Lillian
City
Spokane,
State
WA
Subd' sion/Pla tiam = c �! I� � c�
/.. V Iv �s
Assessors Parcel N , O `
.r
4V 1�
Lot 3
Blac5
Plat M
Applicant
Beverly
Jordan
Address
I N. 4712 Lillian
City
Spokane,
State
WA
Zip
99216
Phone
928-8996
Business Phone
Contractor
Sturm Heating, Inc.
Address
E. 204 Indiana
City
Spokane
State
WA
Zip
T99207
Phone
325-4505
Contact
Carol
License M
STURMI*210 QF
Business Phone
325-4505
Describe Work
Install
Heat Pump
$24.00
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Sol Id Fuel/ Wood Stove
Air Handling Units
0-10,000 CFM
_T
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
9000
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
T 5-30HP
30 50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10v,: W+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-
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 0R DATE `�"