1990, 05-09 Permit App: 90001979 Piping MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project#
Owner's Name Last First MI
Anderal Tom
Project Address(Street Name&Number)
1929 Rocky Ridge Road //9a24
City State Subdivision/Plat Name
Spokane Washington
Assessors Parcel# Lot Block Plat#
Applicant Address
Andy's Heating and A/C P.O. Box 804
City State Zip Phone
Hayden Lake Id 83835 (208) 772-4570
Business Phone
Contractor Address
Shorewood Homes 8191 Lochhaven Drive
City State Zip Phone
Hayden Lake Id 83835 (208) 772-7581
Contact License#CCAAF Business Phone
Nancy Sims Andy;s SHA249LN
(208) 772-6464
Describe Work
Install gas furnace/duct work
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
Air Handling Units 0-10,000 CFM 10,000+CFM
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System
1-100,000BTU 10� 00+BTU
2 water heaters supplied by plumber
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 .DATE 5-9_9n