1986, 01-22 Permit App: 00009519 InsertMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Owner's Name Last First MI
Atwood John
Project Address (Street Name & Number)
S. 2314 Owl Ct.
City
Veradale
State
WA 99037
Subdivision/ Plat Name
EARLy 1:14-ce1N is -7- Apo
Assessors Parcel # 2....&61.2.... / Qoe
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Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
Valley Fireplace
Address
E. 16610 Sprague - PO Box 553
City
Veradale
State
WA
Zip
99037
Phone
922-2780
Contact
License #
VALLEF 177 CG
Business Phone
Describe Work€4303/ t-)
Installation of Lopi Answer intoChimney ,Qc�i.i
Fans
Evaporative Cooler
Hoods
ElectrilFurnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
SPP ahnv
Air Handling Units
�0-10,000CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50H P
50 + HP
Gas Piping
1-5 Outlets
`
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10,,00+BTU
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
OWNER OR
APPLICATION
DATE