1986, 05-15 Permit App 0011114 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY -THOSE PARTS OF THE FORM YOU UNDERSTAND
(Last)
1 Owner's Name (Last) ' r (First) (M) .
i. 0 1 • l 1-,\.. ;`� :: ,
Department Use Only
t /�1
Project No. 1 I ( i 7
2 Project Address (Not Mailing Address) / Space Zi
j p p i
3 City/ mmunity j ,
State
Subdivision/Plat Name
4 A' or Parcel No.
Lot
Block
16 Contractor Firm Name 7
Street Address
17 Zip
City
State
J
Phone
18 Contact Person
License No.
Phone If different than above
I
MUM-20004
8 Owner/Al,gent (if different than 81 above)
`'fl 1 / � .�
��_L ':� i t t_�.{,�_..1_
Business
I I
Address
_ i `TO / ' : S�J��Jk,� l<.t._.;
i ,
9 Zip
c'
a(
City I
v
-_e›.f...G._
State
• Cijo„.__
- Phone /
( )
15 Describe Work:
New 0 Addition/Alteration 0
/
( Replace/Repair '•
10 Applicant Name
(/-
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(s):
Hood(s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s): I
Range s):
Gas Log (s):
Wood Stove!
I Solid Fuel:
Gas Water Heater (s):
11 UNITHEATER(S): Wall Mount: Y N
Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or less:
More than 10,000 CFM:
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. ft.):
15 COMPRESSOR/HP: Less than 3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets: U
17 HEATING SYSTEM: 1-100,000 BTU: �,..) �� - 7• , `
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air • Radiant 0 ; Heat Pump •
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 4 DIVISION or a -, VINO. APPLICATION
OWNER OR E. 931 Ji 1 AVE. DATE S—/5 %
SPOKANL, WA 992Of=
928.825?