1985, 07-23 Permit App: 0006872 Inserts*
1—
z
w
2
a
5
0
w
>
O
w
a
1—
z
w
i
z
Crto
MECHANICAL PERMIT APPLICATION WORKSHEET %� 5
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
L o e r Eric
Department Use Only
Project No.
2 Project Address (Not Mailing Address) Space Zip
11507 E. Fairview 99206
3 City/Community
Spokane
State
WA
Subdivision/Plat Name
i-ftrA CE4 (,{ r?:lt/C-4
4 Assessor Parcel No.
6g5V i- 6406
LotBlock
r f
6 E .
16 Contractor Firm Name
Valley Fireplace
Street Address
E. 16610 Sprague - PO Box 553
17 Zip
99037
City
Veradale
State
WA
Phone
( 509) 922-2780
18 Contact Person
License No.
VALLEF 1770G
Phone If different than above
8 Owner/Agent (If different than #1 above)
Business Address
9 Zip
City
State
Phone y
15 Describe Work: Installation ofpuperheat lecothrbegose inserts hearthS -6'f v�
New ❑ Addition/Alteration CIReplace/Repalr ❑
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(s):
Hood(s):
Duct(a)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I 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. t.):
15 COMPRESSOR/HP: Lessthan3:
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 ❑ ; 011 ❑ ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant 0 ; Heat Pump❑
1* Number of separate zones for any heating, A/C or air handling system.
50
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`�.. APPLICATION 7 os 3 i3
OWNER OR a- Vk:Z �j 10/A.cipAd DATE