1984, 08-03 Permit App: 00001712 FurnaceF
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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)
Department Use Only
¶_4-n1
Project No. /1/Z-
J/l2SeWALRD
2 Project Address (Not Matting Address) l Space Zip
/` / /f/S f1/s5i44
3 City/Community
SPOKAVE
State
c4)4-.
Subdivision/Plat Name
(erbin 4&( 45 C`eenorPs
4 Assessor Parcel No
4 11552- 6/D$
Lot
/0
Block
/
16 Contractor Firm Name
6ANNER 7'RNAI.F St- /—U L(_ �/✓C
Street Address / �/ n
/y /�22 F/FLE/YA-
17 Zip
990?6 ,
City J
J%K/4/14E
State
1,(.119- ,
Phone
(Se 7) 53S77//
18 Contact Person
License No.
I/C37c7NT
Phone If different than above
8 Owner/Agent (it different than #1 above)
Business
Address
9 Zip
City
State
Phone
15 Describe Work- oi),zaft'/'Lo>rg' &/6G,3-75 _i to/ , .4t,4„.ctw
New yQ Addition/Alteration
❑
Replace/ Repair ❑
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
I )
8 VENT Fan(s):
i
Evap Cooler(s):
Hood(sy
_,1j0
Duct(s)1.
Miscellaneous'
10 APPLIANCE:
Dryer(s).
I Range s).
Gas Log(s):
Wood Stove/
Solid Fuel'
Gas Water Heater(s)'
11 UNITHEATER(S). Wall Mount: Y N
Floor: V N
Suspended. Y N
12 AIR HANDLING. 10,000 CFM or less:
More than 10,000 CFM:
13 REFRIG SYSTEM BTU. 1-1o0M:
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' / f.b6
17 HEATING SYSTEM' 1-100,000 BTU:7 /' 000 fe (4•
100,001 + BTU:
18 TYPE FUEL SOURCE' Electric 0 ; Gast A ; 011 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION. Forced Air Al Radiant 0 ; Heat Pump❑
1" Number of separate zones for any heating, A/C or air handling system.
411.2�. SD
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 9d2
APPLICATION
DATE or—i-25/