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1984, 11-30 Permit App: 00003617 Wood Stove1- Z w 2 5 0 w 0 0 w >- > k- 0 Z tu w m i Z MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name (Last) (First) • Department Use Only Evanger Mike % Project No. 2 Project Address (Not Mailing Address) Space Zip E. 7821 Nora 99206 3 City/Community Veradale I State WA Subdrvn/Plat Name �nj BZW Net t S 4 /'/`v 4 Assessor Parcel No 01513 n6io Lot Block '7 /7 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 it different than above 8 Owner/Agent (0 different than 41 above) Business Address 9 Zip City State Phone 15 Describe -CI-) rk ( installation of Firelight woodstove J New 0 Addition/Alteration with brass 0 door, pipe GLicfLs Replace/Repalr 0 t 10 Applicant Name (j Street Address 11 Zip City State Phone ( ) 8 VENT. Fan(s): Evap Cooler(s): Hood(s) Duct(s) 1. Miscellaneous: 10 APPLIANCE: Dryer(s). 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. L). 15 COMPRESSOR/HP. Less than 3: 3-15: 15-30: 30-50: 50+: 16 GAS PIPING SYSTEM: Number of outlets: 17 HEATING SYSTEM: 1-100,030BTU: 100,001+BTU: 18 TYPE FUEL SOURCE: Electric 0 , Gas 0 ; Oil 0 , Coa 0 ; Wood 0 ; Solar 0 19 TYPE DISTRIBUTION. Forced Alr 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 I I �jr/i APPLICATION OWNER OR o I I o.t ISR_ I �l , AC. :9 DATE I/3of q 1 • 4S