2005, 03-31 Notice of Unsatisfactory ConditionS k
• • Va e y
11707 E Sprague Ave Suite 106 ♦ Spokane Valley WA 99206
509.688.0036 ♦ Fax: 509.688.0037 • ddompier@spokanevalley.org
March 31, 2005
Owner
2823 N. Boeing Road
Spokane Valley, WA 99206-4337
RE: Notice of Unsatisfactory Condition — Gas Boiler
Dear Owner:
Our office has been informed by Avista Utilities that an unsatisfactory condition may
exist with regard to the gas boiler located in the mechanical room at 2823 N. Boeing
Road.
This notice is to inform you that should you install new equipment, you must
obtain a permit. Please disregard this notice if a permit has been obtained.
Should you have any questions, please contact this office between the hours of
8:00 a.m. and 5:00 p.m., Monday through Friday. Our phone number is (509) 688-
0036.
Sincerely,
Dawn Dompier
Permit Specialist
qui VISTA
Utilities
Customer Name
Address
TYPE OF
NOTIFICATION:
NOTICE OF HAZARDOUS CONDITIONS
4114-1
/.t/
Phone Number
City ,
S-0308 (08-01)
❑ HAZARD The conditions noted below constitute an immediate hazard and may result in property damage, personal injury, or loss
of life. The equipment has been disconnected or left inoperable, and shall not be turned back on until such repairs have been completed
by a qualified HVAC dealer, contractor, or service agency, and the equipment has been brought up to current safety standards. Do not
attempt to use this equipment until it has been repaired.
Equipment Type:
CONDITIONS
FOUND:
Location:
❑ Apparent cracked or restricted heat exchanger ❑ A gas leak in your house piping in the amount of
with all known appliances off
❑ Insufficient combustion/ventilation air
❑ Other
❑ Damaged appliance connector
❑ Damaged or disconnected vent
❑ Gas leak at gas equipment
CFH
1..
L
G
Meter Left ❑ Off ❑ On Meter Number Meter Read
I have read, understood and acknowledge receipt of this notice. ❑ Owner ❑ Tenant ❑ Agent
Customer Signature -%` ❑ Refused to Sign
Service Representative ";.,A�• ?► "/ 5 Date 'e Time
White Copy - Customer Yellow Copy - Attach to Service Order Pink Copy- Authority Having Jurisdiction HardCopy- Appliance
am/pm