1985, 10-22 Permit App 00008229 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project #
Owner's Name Last First \ MI
PINECROFT TRAILER COURT ( f�JSV /)
Project Address (Street Name & Number)
E. 12126 Mansfield
City
Spokane
State
99206
Subdlvislon/Plat Name
I Cb,F-T" Pt3.-)1/0U 1
Assessors Parcel #
O c 4 - 0130
Lot
Block
Plat #
Applicant
GAS SERVICE
COMPANY
Address
N. 322 Freya
City
Spokane
State
WA
Zip
99202
Phone
535-2215
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work Piping from meter to furnace. Instal] 100,000 Btu
Rheem Furnace
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel l Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-3OHP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
1 Q ,�00 + BTU
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 '4C4 / e ,7' ---,. DATE d ~ ,ZZ �