1985, 02-08 Permit App: 00004130 Fireplace 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 OnlyA.( „�
Davis Mike f
Project No. i�j{`�)
2 Project Address (Not Mailing Address) Space Zip.
E. 14413 Nixon 99216
3 City/Community
Spokane
State
WA
Subdlvl�lQn/plat Name
/�/,�%
"D G�l�`�
4 Assero4 Pa5rce.leiNo
...
Lot
I Block t
16 Contractor Firm Name
Valley Fireplace
Street Address
E. 16610 'Sprague
17 Zip
99037
City
Veradale
State
WA
Phone
( 509) 922-2780
18 Contact Person
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 of Nighthawk woodstove
New ❑ Addition/Alteration
insert, hearth
❑ Replace/Repair ❑
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(s):
Hood(s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s): 1
Range s):
Gas Log(s):
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 10,000 CFM:
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. ft.):
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 0 ; Gas 0 ; 011 0 ; Coal 0 ; Wood 0 ; Solar 0
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 ,n,_ APPLICATION
OWNER OR Ca. ,Q.( L'h ,,6e(-241 C DATE
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