1985, 12-30 Permit App: 00009307 Mechanical Fixtures MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project#
Owner's Name Last First MI
Hensley Gerald
Project AddressStreet Name&Number)
S. 5011 Van Marter
City State Subdivision/Plat Name S a `76 -064
Spokane WAS.- .r=Lt - MrPm'. 8
Assessors Parcel# oh/2_ `'2 Lot lza Block Plat#
Applicant Address
Hensley Gerald S. 5011 Van Marter
City State Zip Phone
Spokane WA 99206 926-8570
Business Phone
Contractor Address
Sturm Heating 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
Install new gas furnace
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
3.00
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor
0-3HP 3-15HP 15-30H P 30-50H P 50+HP
1-5 Outlets2.00•00 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10, 00+BTU
7. 50
fee 10 .00+12 . 50=22. 50
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 ._ L" -f APPLICATION
OWNER OR C - -L/YI .DATE - J s