1985, 10-03 Permit App: 00008149 InsertY
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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cer
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
frivz . ry cj1
APPLICATION /
DATE
Project # ,�"' / ` /
(`�
Owner's Name Last First MI
Hendrickson Janet
Project Address (Street Name & Number)
N. 4315 Progress
City
Spokane
State
WA 99 216
Subdivjon/Plat Name
/rE/Ur" /
o COW -5e H/ o %
Assessors Parcel #
02_5(k ----E-76/
Lot
r
Block
2 -
Plat #
Applicant
Applicant
Address
City
State
Zip
Phone
Business
Phone
Contractor
Maagiaka Valley Fireplace
Address
E.
16610 Sprague - PO Box 553
City
Veradale
State
WA
Zip
99037
Phone
922-2780
Contact
License #
VALLEF 177CG
Business
Phone
Describe Work Installation of Convector Classic I woodstove insert
and hearth extention
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water
Htr.
Solid Fuel/Wood Stove
+
Air Handling Units
0-10,000 CFM
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
30-50HP
50+ HP
Gas Piping
1-5 Outlets
6 + Outlets
Gas Fired Heating System
1-100,000BTU
10v,:.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
frivz . ry cj1
APPLICATION /
DATE