1985, 01-22 Permit App: 00003986 Insert 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 Only ,n (�
Bren Ted Project No. / 1 L,}
---Z Project Address(Not Mailing Address) Space Zip
S 707 Progress
3 City/Community State Subdivision/PlatdName
Spokane Wash V IAA. p,,,,rArA. 010
4 Assessor Parcel No. Lot 1 Block
"?3 54 ( --- 2.v 35" 6 f
4
16 Contractor Firm Name ��- Street Address
Pleasant Prairie Farms Custom Mfg. Inc. E 7827 Bigelow Gulch
17 Zip City State Phone
99207-9698 Spokane Wash (50924676760
18 Contact Person License No. Phone if different than above
J. Gramlow 223 01 Pleasi* 229JE
W
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
15 Describe Work: Custom Insert installed
New ❑ Addition/Alteration ❑ Replace/Repair ❑
10 Applicant Name Street Address
11 Zip City State Phone
( )
*
*
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
10 APPLIANCE: Wood Stove/
Dryer(s): Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
I— 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
Z
W
a.. 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
0
13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
L.L.
0
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a
>-
l—
Cl 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
Z
Q
W 16 GAS PIPING SYSTEM:Number of outlets:
m
2
D 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
Z
18 TYPE FUEL SOURCE: Electric ❑ ; Gas 0 ; Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; 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 APPLICATION
OWNER OR DATE