1986, 01-22 Permit App: 00009520 Wood StoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
/26/5 /40 -
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 \Ct,l -9.4 w C
APPLICATION
DATE t ci I / nn
�` '� f d./q--4/7
Project B 6/52/9
Owner's Name Last First MI
Franklin Duane
Project Address (Street Name & Number)
E. 13310 Cata'1do
City
Spokane
State
WA 99216
Subdi n/Plat Name \ /
Le7!llEf 6 V /4LLEV-/ 1 L/ rfL
Assessors Parcel q ,55 `/ ^ (9n 0
J7L V L
Lot
Block�
I Plat N
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
Valley Fireplace
Address
E. 13610 Sprague - PC Box 553
City
Veradale
State
WA
Zip
99037
Phone
922-2780
Contact
License ft
VALLEF 177 CO
Business Phone
Describe Work
Installation of Convector II wood gtove, blower, pipe
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Wate Htr.
Solid Fuel/Wood Stove
yes, see above
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 -151 -IP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6 + Outlets
Gas Fired Heating System
1-100,000BTU
10.,,: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
OWNER OR \Ct,l -9.4 w C
APPLICATION
DATE t ci I / nn
�` '� f d./q--4/7