1985, 10-07 Permit App: 00007872 Woodstove MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# / 1 L—-
Owner's Name Last First MI
Cr itchf field Arthur
Project Address(Street Name&Number)
S. 1617 Keller
City State Subdivision/Plat Name
Spokane WA 99216 QPPOYL--rutveTY -6f /Z4 612.Weee,
Assessors Parcel# Lot Plat#
�.1541 —t'1i�
�3 3 1-300,16
Applicant Address
City State Zip Phone
Business Phone
Contractor Address
Valley Fireplace E. 16610 Sprague - PO Box 553
City State Zip Phone
Veradale WA 99037 922-2780
Contact License# Business Phone
VALLEF ,177CG
Describe Wort Installation of Convector I Supreme woodstove insert
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000CFM 10,000+CFM
Air Handling Unita
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor 03HP 3-15HP 15-30HP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 104,,Z.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. ( J
SIGNATURE OF APPLICATION q , i
OWNER OR ��� 111 000 DATE �� ,