1985, 03-29 Permit App: 00004703 Mechanical Fixtures•
NUMBER AND TYPE OF EQUIPMENT
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name
(Last)
Flu&ey
2 Project Address (Not Mailing Addr6ss)
S 3qoa LokF+-4A
(First) (M) Department Use Only
LA22y Project No.
J Space Zip
3 City/Community
SPOKANE.
State
woci Sfml.
Subdivision/Plat Name
4 Assessor Parcel No.
16 Contractor Firm Name
T R i Uni,�ed AEEA-Tiw6
Lot
Block
Street Address
�l 13i8 /YI4P4E
17 Zip
99at
18 Contact Person
City
S Po A
State
i4
Phone
) 39.C— S CO
—PO A.I rv`cs g_ + S
License No.
u ?Jai 1 5 7Co
Phone If different than above
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
15 Describe Work:
New t8
Addition / Alteration ❑ Replace/Repair ❑
10 Applicant Name
Street Address
11 Zip
City
State
Phone
8 VENT: Fan(s):
Evap Cooler(s):
Hood (s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
IRange s)1
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas WaterHeater(s): /— 4O, COAL -
11 UNITHEATER(S): Wall Mount: Y N
Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or less:
More than 10,000 CFM:
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. t.):
15 COMPRESSOR/ HP: Less than 3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
411150X1Rett291t— —1-1.00
r
17 HEATING SYSTEM: 1-100,000 BTU:
IOo,000 l3T1)
100,001 + BTU:
18 TYPE FUEL SOURCE:
Electric ❑ ; Gas X. ;
Oil ❑ ; Coal ❑ ;
Wood ❑ ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 1X ;
Radiant 0 ; Heat Pump
1* Number of separate zones for any 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
OWNER OR
APPLICATION
DATE 3 c9 'c95