1984, 11-30 Permit App: 00003617 Wood Stove1-
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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) •
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
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