1984, 09-12 Permit App: 00002244 Fireplace InsertMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
NUMBER AND TYPE OF EQUIPMENT
1 Owner's Name
iLast)
Vestal
(First)
Ralph
(M)
Department Use Only
Project No.
2244
2 Project Address (Not Mailing Address) Space
519 N. Bates
Zip
99206
3 City/Community
Spokane
State
WA
Subdivision/Plat Name
4 Assessor Parcel No.
Lot
Block
16 Contractor Firm Name
Valley Fireplace
Street Address
E. 16610 Sprague
17 Zip
99037
City
State
Veradale WA
Phone
( 509 922-2780
18 Contact Person
License No.
VALLEF 177CG
Phone if different than above
8 Owner/Agent (If different than N1 above)
Business Address
g Zip
City
State
Phone
( 1
15 Describe Work: Install Lopi 1X insert and red half moon hearth extention
New Addition /Alteration 0 Replace/Repair 0
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( 1
8 VENT: Fan(s): EvapCooler(s):
Hood 5):
Duct(s) 1: Miscellaneous:
10 APPLIANCE:
Dryer (s):
Range(s):
Gas Log(s):
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: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. t.):
15 COMPRESSOR/HP: Less than 3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU:
100.001 + BTU:
18 TYPE FUEL SOURCE:
Electric 0 ; Gas 0 ;
011 ❑ ; Coal ❑ ;
Wood n ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ;
Radiant rJ ; Heat PumpE
1* Number of separate zones for any heating, A/C or air handling system.
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 q
6frconstruction.
SIGNATURE OF APPLICATION
OWNER OR DATE