1986, 10-03 Permit App: 00013647 Insertc42 _
MECHANICAL 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 '1 H 11
OWNER OR L , JI•. .vv -t -T • Jcwr /G
APPLICATION
DATE ! U I ? ��
Project#
Owner's Name Last First MI
-3 ()tie hLA h
,(n
Protect Address (Street Name & Number
F. //•362 //7/akwzu--I-City
crnkAli e
State
WA-
Subdivision/Plat Name
iUlCKI*1\19 fi-» C
AssessoYs Parcel!,
I
4 L ' D 3 I
� --42.-,
Lot
Block
Plat p
Applicant
0Ai--L eJ L� -7---1, epi -A0 C-1
Add ass
P 0, a rk cc3
City
ifer eiOfC,
State
1.1 A
Zip
G'yo3 -7
Phone
i;)D -D-7g0
Business Phone
Contractor
U A1.-4 .c) r14.- t ipt-ae U
Address
f 0.6�7<- ss
City
tri -82rndAiz
State
GOO
Zip
97o� 7
Phone
9.)2-a74C)
Contact
License #
VAI—L- E r 6 G- /? 7
Business Phone
n ,. t\ ,
/� p -LA-6.4) -1.0
Describe Work p,tvp�C 1101.6:21.€41/4._ :tL�! S ovc �l � dez.A.kh.A.Lir..) 1. tt.zt 4YV Gam: Orn C✓., Dim_ -
Fans if
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Hir.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM
10,11()0+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30.50HP
50-F HP
Gas Piping
1-5 Outlets
8+ Outlets
Gas Fired Heating System
1-100,000E1TO
1#,,;,00+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 '1 H 11
OWNER OR L , JI•. .vv -t -T • Jcwr /G
APPLICATION
DATE ! U I ? ��