1984, 12-11 Permit App 00003708 Furnace, Ht PumpMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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1 Owner's Name . (M)
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Department Use Only
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Project No.
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2 Project Address (Not Mailing Address) Space Zip
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3 City/Community
State
Subdivision/Plat Name
4 Assessor Par el No.
Lot (Block
1
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16 Contr for FirNames .I� CCC»�CC AAAJJJ����"y
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17 Zip
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State
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Phone
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18 Contact Person 7
License No.
AL-DE-W*2255M
Phone if different than above
8 Owner/Agent (if different than #1 above) l Business Address^,�- j�
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9 Zip
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City
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State
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Phone
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15 Describe Work:
New j Addition/Alteration 0 Replace/Repair 0
10 Applicant Name
Ci.---1 �- ,
Street Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(s):
Hood(s):
Duct(s)1: ( ) ,
�J
Miscellaneous:
10 APPLIANCE:
Dryer(s): I Range s):
Gas Log(s):
I Wood Stove/ 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: 1-100Ma'/Feg 0
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. ft.):
15 COMPRESSOR/HP: Less than 3:
1 3-15:
15-30:
130-50:
150+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU •--_ • iq .7 11
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric Gas ❑ ; Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat PumK
1" Number of separate zones for any heating, A/C or air handling system.
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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
OWNER OR
APPLICATION j I(o5
DATE
DATE
Soolkane County
-calm District
Wesr 1101 College Avenue Spokane. Washington 99201
`%�
RE: PROJECT DESCRIPTION
PROJECT ADDRESS
d /iaaw-a 2 ag,d607
Please be advised that the above -referenced proposal is being
given a zreliminary release to accommodate the "fast track"
concept regarding this project. Note that this is not to be
deemed an approval. The project will be reviewed by Spokane County
Health District's Environmental Health Division in more detail,
and a final approval by Spokane County Health District's Environ-
mental Health Division will be required prior to your proceeding
with this project.
The undersigned owner/applicant/sponsor does hereby agree to comply
with the regulations of Spokane County which will be imposed onto
the proposal subsequent to the "fast trsck" early start process.
Ai
(date)
If you have any questions, please tali the Environmental Health
Division office at (509) 456-6040, and ask for Mr. Dennis Kroll or
Daryl Way.
c: Building Codes Department
Administration 456-3630 Personal Health 456-3613 Environmenrcl Health 456-6040
Clinic 456-3640 Vital Statistics 456-3670 Lobororory 456-3667
An Equal Opportunity Employer
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