1985, 07-02 Permi tApp: 00006994 Furance*
iv.�
2
MECHANICAL PERMIT APPLICATION WORKSHEET ----- eo
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Zc
1 Owner's Name (Last) (First) (M)
G t K A kA bo&)
Department Use Only
Project No.
2 Project Address (Not Mailing Address) Space Zip
3 3501 fr02Ei4A
3 City/Community
SPOKA,.1E
State
wASµ
Subdivision/Plat Name
4 Assessor Parcel No(5
3q2)
Lot
I Block
Eggi%L %
16 Contractor Firm Name
Tei it V E4 DEPT r4g
Street Address
N i 3 t$ MP.. .
17 Zip
9 `12o 1
City
S Po -A4./ z
State
Cr/4S R.
Phone
( ) 3 a 6_ s-4,00
18 Contact Person
Rom
License No.
7-72r u"µs
.S7co
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business
Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New tit Addition/Alteration
❑
Replace/Repair 0
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):
I Range s):4
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater (s):
11 UNIT HEATER(S): Wail 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:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric X; • Gas 0 ; Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air F( ; Radiant 0 ; Heat Pump El
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 v
OWNER OR .Cam .1"7/
APPLICATION
DATE
*