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1985, 11-12 Permit App: 00008833 Heat Pump • • MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Project# E"a5 Owner's Name Last First �MI Mayer Bernice Project Address(Street Name&Number) N. 4905 Rees Rd. _ C92J, City State Subdivis n/Plat Name Spokane WA NC) KSel>n/ s ug Assessors Parcel# j /6 1 Lot Block Plat# T /� eC Applicant 1L Address J� same same City State Zip Phone Spokane WA 99216 Business Phone Contractor Address Sturm Htg. E. 204 Indiana City State Zip Phone Spokane WA _ 99207 325-4505 Contact License# Business Phone Diane ST-UR-MI-210-QF 325-4505 Describe Work $20 .00 0 .O0 Install 2 ton heat dump Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove 0-10,000 CFM 10,000+CFM Air Handling Units Refrigeration Systems/ 1-100M 101-500M 501-1,000M Heat Pumps(BTU) 1,001-1750M Over1750M Compressor 0-3HP 3-15HP 15.3OHP 30-50HP 50+HP 1-5 Outlets 6+Outlets Gas Piping Gas Fired Heating System 1-100,000BTU 10%,,,:,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 APPLICATION OWNER OR � �Q -- .DATE //-/Z ��'S—