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1984, 08-15 Permit App: 00001848 Insert
MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 _ Owner's Name (Last) Franklin (First) (M) Forrest Department Use Only Project No. 2 Project Address (Not Mailing Address) S. 4309 Darcy Dr. Space Zip 99206 3 City/Community Spokane State I WA Subdivision/ Plat Name Z—:,.S�C-"74eS 4 Assessor Parcel No, Lot Block 16 Contractor Firm Name Valley Fireplace Street Address E. 16610 Sprague 17 Zip 99037 City Veradale State WA Phone (509)922-2780 18 Contact Person License No. VALLEF-177CG Phone if different than above 8 Owner/Agent (if different than #1 above) Business Address 9 Zip City State Phone 15 Describe Work: L®pi lj(,jinee>•rt New ❑ in mae©nary fireeplace Addition/Alteration ❑ Replace/Repair ❑ 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: 100-50OM: 500-1000M: 14 1000-175OM: 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 ❑ Gas ❑ Oil ❑ Coal ❑ Wood X; Solar ❑ 19 TYPE DISTRIBUTION: Forced Air ❑ Radiant; Heat Pump 1" Number of separate zones for any heating, AIC 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. JOA�Le9 SIGNATURE OF APPLICATIONOWNER OR C�DATE C� %