1984, 09-04 Permit App: 00002135 Furance*
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
JIM BROSE CONSTRUCTION
Department Use Only / 36v
are
2 Project Address (Not Mailing Address) Space Zip
S. 3617 Loretta Drive 99206
3 City/Community
Spokane
State
Washington _
Subdivision/Plat Name
4 Assessor Parcel No.
I Lot
,
I Block
16 Contractor Firm Name ANDERSON is SHEETMETAL Street Address
FTEATTNG & AIR CONDITIONINGr E. 13903 Trent Ave.
17 Zip
99216
City
Spokane
State
Washington
Phone
1,( 509) 928-0960
18 Contact Person
Erio Rio Anderson
License No.
ANDERSH213NZ
Phone if different than above
8 Owner/Agent (if different than 81 above)
Business
Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New Z Addition/Alteration ❑
Replace/Repair ❑
10 Applicant Name ANDERSON'S SHEET METAL
HEATING & AIR, CONDITIONING
Street
E.
Address
13903 Trent Avenue
11 Zip
99216
City
Spokane
State
Washington
Phone
1( 509)928-0960
8 VENT: Fan(s):
Evap Cooler(s):
Hood(s):
Duct(s)1:
10
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I Range s):4
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
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:
17 HEATING SYSTEM: 1-100,000 BTU: Rheem 2I KW Elec. Heating io,s��
100,001+ BTU:
18 TYPE FUEL SOURCE: Electric XX; Gas 0 ; Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air Xi; 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 (
zric R. Anderson) owner
APPLICATION
DATE 9-4-84