1986, 01-27 Permit App: 00009587 Furance•
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M) Department Use Only
,c..k. (,,,_,...L.1... , + Project No. 17
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2 Project A. dress (Not Mailing Address) F,, Space Zip
y
3 City/Commu " y
LS.__
State
L_k j ',L._
Subdivision/Plat Name
4 Assessor P el No.
Lo 1 Block
16 Contracjor Firm Name . --<
(_).,_ (,.c V.A.L._ c -e* ,-14.._i.,\.-t..-t", —
Str Address
s,,,.......
r._,7";3//4:-A-
,7";I/�\� 1�
17 Zip 1
C/ fff
City
State
Phone
/
18 Contact Person
.
License No.
Phone If different than above
1111111.20004
1
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8 Ownei...6.- ____tire Ltabove)
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A
C`, ,rasa /5/j F-
9 Zip
�G. ) iG'{s
'r T"/ /
City •
)
°" ..._.Q� �"'C mil _
State
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Phone
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15 Describe Work:
New X Addition/ Alteration
0
Replace/Repair 0
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
i
Evap Cooler(s):
L
Hood s):
Duct(s)1: x67 ,..3 6)
_
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I
I Range s):'s
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNITHEATER(S): Wail Mount: Y N
Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or Tess:
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: Lessthan3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU: '-jT' ' .-e
100,001 +BTU:
18 TYPE FUEL SOURCE: Electric "; Gas 0 011 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Alr Radiant 0 ; Heat Pump
1* Number of separate zones for any heating, A/C or air handling system.
2/ c�
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.
ALDENDORF FURNACE
SIGNATURE OF A SIM OF ALLIED HEATING, INC APPLICATION
OWNER OR E 4311 TREK! AVE. DATE ° / �
SPOKANE, WA 99206