1985, 01-22 Permit App: 00003989 InsertH
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
Department Use Only �j (�
Sewell Eric
Project No. 3 (J 2)
2 Project Address (Not Mailing Address) Space Zip
E 11916 Maxwell
3 City/Community
Spokane
State
Wash
SubdivmwnlPlat Name / �7
Of/QMi / Hr 5'S r0 Ad ! A1C,
4 Assessor Parcel No
/ 5c/ / — o l rf8
Lot
E-
Block
16 Contractor Firm Name
Pleasant Prairie Far s Custom M4,g. Inc.
Street Address
E 7827 Bigelow Gulch
17 Zip
99207-9698
City
Spokane
State
Wash
Phone
(509)467 6760
18 Contact Person
J. Gramlow
License No.
223 01 PLEASI*229JE
Phone if different than above
8 Owner/Agent (if different than 41 above)
Busi ess Address
"9 Zip
City
State
Phone
15 Describe Work: Custom Fireplace Insert
New ❑ Addition/ Alteration 0 Replace/Repair ❑
10 Applicant Name
Street Address
11 Zip
City
State
Phone
1 )
8 VENT' Fan(s):
Evap Cooler(s).
Hood ):
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
Range s):
Gas Log(s):
Wood Stove/
Solid Fuel'
Gas Water Heater(s):
11 UNITHEATERIS). Wall Mount. Y N
Floor: Y N
Suspended: Y N
12 AIR HANDLING. 10,000CFM or less'
More than 10,000CFM:
13 REFRIG SYSTEM BTU 1-10DM•
100-500M:
500-1000M:
14 1000-1750M'
Other:
Pressure Vessel (cu. t.).
15 COMPRESSOR/HP' Less than 3:
3-15:
15-30: 1
30-50:
50+.
16 GAS PIPING SYSTEM: Number of outlets'
17 HEATING SYSTEM: 1-100,000 BTU:
103,001+ BTU:
18 TYPE FUEL SOURCE Electric ❑ ; Gas ❑ ; 011 ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air 0 ; 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
APPLICATION
OWNER OR DATE
2 4o