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1985, 05-30 Permit App: 00005830 Heat Pump MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Project# 5-13 Owner's Name Last First MI Sauve Jerry Project Address(Street Name&Number) S. 3007 Wilbur Rd. City State Subdivision/Plat Name Spokane WA Assessors Parcel s41.4 1 I y Lot s Block Plat# Applicant Address Sauve Jerry S. 3007 Wilbur Rd. City State Zip Phone Spokane WA 99206 926-8187 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 heat pump Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove Air Handling Units 0-10,000CFM 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 15-30H P 30-50H P 50+H P 1-5 Outlets 6+Outlets Gas Piping Gas Fired Heating System 1-100,000BTU 10.,L00+BTU fee $ 20 .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 APPLICATION OWNER OR iti-/"./14/i2 .DATE '�5