1984, 10-14 Permit App: 00002896 Dampers f Z,
' MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name ' (Last) Al ( first) (M) Department Use Only
L'u.1..2. y r4.,,,,,) _, L- /L. L„' Project No.
2 Project Address(Not Mailing Address) Space Zip
/q7 , o t..� -- q'(77
3 City/Community State Subdivision/Plat Name
/ \
4 Assessor Parcel No. Lot Block '
/
t r-6 - 4''1> J i 3 2t
16 Contractor Firm Name Street Address
REYNOLDS FURNACE CO.
17 Zip N. 6303 SLY1ttfERLiN State Phone
SPOKANE. WA 99208 ( )
Ph: 327-1924
18ntact Person Li -nse No; Phone if different than above
V i,71 .,„4� .1 � 4 i! /....
,.
8 Owner/Agent(if different than#1 above) Bu iness Address
9 Zip City State Phone
( )
1 \Describe Work: ,��� y �,,.-4,0
�) ng
clew t `� / Addition/Alteration ra` Replace/Repair ❑
10 Applica Name Street Address
11 Zip City State Phone
( )
* . *
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
10 APPLIANCE: Wood Stove/
Dryer(s): Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
I-- 11 UNIT HEATER(S): Wall Mount: Y N Floor: V N Suspended: Y N
Z
W
d12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
0
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
U-
0 -
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a
>I-
0 15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 30-50: 50+:
Z
Q
W 16 GAS PIPING SYSTEM:Number of outlets:
m
2
ZD 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; Heat Pump ID
1* Number of separate zones for any heating, A/C or air handling system.
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 0 — APPLICATION // r/ �.'.,/
OWNER OR l e-0.'�vL _4, ,-7 -� ° ., DATE c_Il�' 17-t