1988, 09-29 Permit App: 88003188 Pellet StoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project #
Owner's Name ,tet First MI
CIA IY,n 13rl`an
Project Address (Street Name & Number)
/9/42 / E /14C -Ali /lan a1i
City
ac.r^es
State
WA
Subdivision/Plat it
Nam .�, /'
. O f I,-, Ge -1, S L/
Assessors Parcel #
Lot I
Block
Plat #
Applicant
Address
City
State
Zip
L
Phone
Business Phone
Contractor`j�//��,i,.�/ %��% � �� /��
7L
I U1 Nal ! N 1'41
Address
City�,04.6iv-
State
1ivA
Zi
(GN Z
Phone,-_ �-
Q I) 53 -8 ('' 6
Contact
P d .,-,L.
License #
ToPIMe s /f /4 G
Business Phone
Describe ..rnsa/1a / //d -
Fans
Eva rative Cooler
Hoods,
Electric Furnace/Ducts
r Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel /Wood Stove
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
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
104,,. 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
MA/Al co n
0 APPLICATION TC 9 ,2q —�1P
ne