1985, 08-09 Permit App: 00007130 Wood Stove•
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MECHANICAL PERMIT APPLICATION WORKSHEET, q
150
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) ' (First) (M)
Richards Tim
?i
Department Use Only 7/3
Project No. Ci
2 Project Address (Not Mailing Address) Space Zip
E. 7819 Mission 99212
3 City/Community
Spokane
State
WA
Subdivision/Plat Name
54/1/4r//1 R054 rl etie
Ri'
Q"
4 Assessor Parcel No.
01� -662/
Lo
23
Block
5
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
I 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• Installation o Convector I woo
New ❑ Addition/Alteration
stove, hearth, pipe
❑ 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):
I Range s):
Gas Log(s):
I Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNITHEATER(S): Wall Mount. Y N
Floor:
Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or less'
More than 10,000CFM:
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. t.)
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 0 ; Oil 0 ; Coa 0 , Wood ❑ ; Solar D
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 , 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 0
OWNER OR Cz-
' APPLICATION 4/
atif _Q 1 i DATE `"0/r)/ 7�