1985, 11-25 Permit App: 00008975 Insert![9 ( o
MECHANICAL PERMIT APPLICATION WORK$WEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
•.
[Project r1
Owner's Name Last First MI
Lund Lloyd
Project Address (Street Name & Number)
11824 E. Lenora
City
Spokane
State
WA 99206
Subdivision/Plat Name
5 tilt w ADDIi10
2 rcq l._ I& I p
Lot i O
Block
k /
Plat p
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
Valley Fireplace
Address
E. 16610 Sprague - P.0 Box 553
City
Veradale
State
WA
Zip
99037
Phone
922-2780
Contact
License p
Business Phone
P
Describe Work/
- UU j
Arrow 1600 wood stove insert (.(q �ti tc0.40t/I 5--f '
Fans
Evaporative Cooler I
Hoods
Electric FL mace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
yes, see above
Air Handling Units
010,000 CFM
10,000+ CFM
Refrigeration Systems)
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
1Q,,:.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
\GLLtt2`TI, Jam,),,,,,
DATECATION « '77
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