1985, 12-04 Permit App: 00009122 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Qvnd'e Name IIIN).'Cepnnom
Use Only
P tier No.
Y Proleet Erne Not Mallin, AEdreM) 7�, 9pYe ZIP
60 a 0 — o
3 Cityl Community
See 1
W U—
BUOdlvlelonlPlat Name
a Aeasfor Pareel NCO
L01
.,.a
10 Cmtracbr Firm Name
I Slr dreg
,> 9pC ( io
city
StateC LJ4,—
Plarn
( )
19 Cont.l Perron U NoPhone Balnerahtmeraov0
nuiomooi
0 QvnalAged iffienet thanes Aide) Bwl Addrep '
9 9p
O"V
at.
Phone
15 DepiCp Work:17
New MOItIonlAltentldn ❑ ReplewlRepeir ❑
10 Applicant Name
w #/b
Blreel Md.
11 Zap city
finite
Phone
)
B VENT: Feel:
Evep Cooiap):
Hoodp):
DialMl:
Mlecellaneoue:
10 APPLIANCE:
IYyap):
Rangele):
Gae Log(l):
Wood Btovel
stab Fuel:
Gu Wtln Heeter(e):
11 UNITHEATEAE): ~W M: Y N
Flop: Y N
Banderole: y N
12 AIRHANDUNG: 10,0NOCFMplen
Moro line 10,000 CFM:
13 REFRIO SYSTEM BTU: 1-1004,1: /2
1p0.WOM:
5081000th:
H 100617WM:
Other:
Pinafore veal(cu. N.):
15 COMPRESSORIHP: LM, than 3:
115:
15-]0:
16 GAB PIPING SYSTEM: Nurser of outlets:
17 HEATING SYSTEM: 1-100,gD BTU: -
�j L
1W,OOI+BTU:
18 TYPEFUELSOURCE: Elecirio Gu ❑ ; Oil ❑ ; Coal ❑ ; Wand ❑ Sol. ❑
19 TYPEOIBTRIBUTION: Fpwd Air ❑ ; Redlant ❑ ; Hui Pu
1* Number of separate zones for any heating, AIC or air handling system, ai
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.
fey -i a'; � *V FURNACE
FURNACESIGNATURE OF A Dlv6c;r-:: r'= ILLIED HEATWCa. MSC APPLICATION
OWNER OR - - aEKAVE. DATE
SPOr'J1E, WA 99M
1284 252