1984, 11-23 Permit App: 00003518 InsertMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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1 Owner's Name (Last) (First) (M)
Department Use Only
Power Gerly
Project No. 3 Slew
2 Project Address (Not Mailing Address) Space Zip
S. 313 Burns Rd. 99216
3 City/Community
Spokane
State
WA
Subdivision/Plat ame
OQZ (Lrdz A®i'D
4 Assessor Parcel No.
'z.'2- 541 3 CC,
Lot
Block
16 Contractor Firm Name
alley Fireplace
Street Address
E. 16610 Sprague
17 Zip
99037
City
Veradale
State
WA
Phone
( 509) 922-2780
18 Contact Person
License No.
VALLE F 17
7CG
Phone if different than above
i
8 Owner/Agent (if different than #1 above)
Business
Address
9 Zip
City
State
Phone
( )
15 Describe Work: Installation of Arrow 1600 woodstove
( New ❑ Addition/Alteration
insert for
❑
Heatalator fireplace
Replace/Repair D
li 10 Applicant Name
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
Evap Cooler(s):
Hood(s):
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
Range s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater (s):
11 UNIT HEATER(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:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric E. ; Gas ❑ ; Oil ❑ ; Coal ❑ ; Wood C ; Solar E
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; 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
OWNER OR
APPLICATION
DATE
I,^r 3(49