1985, 09-03 Permit App: 00007391 Woodstovei
f-
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
SP?
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 1 I X APPLICATION 9 3�
[1WNFR C1R 0.- �—¢' t,'6 ,,,eeeyyy�.i�C3�G� I7oTF
Project # /
Owner's Name Last
Leach
First
J im
fel
41
Project Address (Street Name & Number)
S. 1117 Mica Park Drive
City
Spokane
State
WA 99212
Subdivision/ Plat Name
Jul to q- P Q k o400
Assessors Parcel#
Lot
Block
Plat N
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
Valley Fireplace
Address
E. 16610 Sprague - PO Box 553
City
Vera dale
State
WA
Zip
99037
Phone
9 22-27 80
Contact
License #
VALLEF
177CG
Business Phone
Descrlbe Work installationo onve c for woo stove with
roug the wall pipe package
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Units
0-10,000CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
7-
1,001-1750M
Over 1750M 1z
Compressor
T73HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,0008TU
10v,.A0+8TU
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 1 I X APPLICATION 9 3�
[1WNFR C1R 0.- �—¢' t,'6 ,,,eeeyyy�.i�C3�G� I7oTF