1984, 06-05 Permit App: 00000614 Heat Pump, Furnace .1
r
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
Kohn Richard Project No.
2 Project Address(Not Mailing Address) Space Zip
E. 14802 Rockwell phone: 922-8813 99216
3 City/Community State S ivision/Plat Name ��A t
Spokane WA I !�'d�t01O oV OUAA li
4 Assessor Parcel No. Lot Block I
Z'S ' . * 4°°4
16 Contractor Firm NameStreet Address
STURM HTG. E. 204 Indiana
17 Zip99207
City Spokane State WA Phone
(509 )325-4505
18 Contact Person License No. Phone if different than above
Diane ST-UR-MI-210-QF 2230/ same
8 Owner/Agent(if different than#1 above) Business Address
same
9 Zip City State Phone
( )
15 Describe Work: Install Heat Pump & gas furnace
New 0 Addition/Alteration In Replace/Repair 0
10 Applicant Name Street Address
11 Zip City State Phone
( )
* *
8 VENT: Fan(s): 3.00 Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
10 APPLIANCE: Wood Stove/
Dryer(s): I
Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
I- 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
W
2
a 12 AIR HANDLING: 10,000 CFM or less: 4 .50 More than 10,000 CFM:
5
0
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
U-
O
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a
>I—
O 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
Z
Q
W 16 GAS PIPING SYSTEM:Number of outlets: 2 .00
m
2
ZD 17 HEATING SYSTEM:1-100,000 BTU: 6 .00 100,001+ BTU: 7 . 50
18 TYPE FUEL SOURCE: Electric ? ; Gas x❑ ; Oil ❑ ; Coal ❑ ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; Heat PumpE
1* Number of separate zones for any heating, A/C or air handling system. 23.00 plus 10 .00 fee
total $33.00
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� J �747 /� APPLICATION ( -s-S"V
/ �`��� y DATE