1984, 09-12 Permit App: 00002246 Woodstovew
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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)
(Mji
Department Use Only
ProJect No.
2
Project Address (Not Mailing Address)
Space c� Zip
3
City/Comm nity
State
SubdivisionIPlat Name
M101 (-=21JD
4
Assessor Parcel No.
335 { 1- Zoo
Lot
Block
16
Contractor Firm Name
Valley Fireplace
Street Addre
I E. 19610 Sprague Avenue
17
Zip
99037
City
Veradale
State
WA
Phone
(509) 922-2780
18 Contact Person
License No.
VALLEF 177CG
Phone if different than above
8
Owner/Agent (if different than k1 above)
Business Address
9
Zip
City
State
Phone
15
Describe Work: Install Convector II stove
New ❑ Addition/Alteration ❑ Replace/Repair ❑
10
Applicant Name
Street Address
11
Zip
City
State
Phone
8
VENT: Fan (a):
Evap Cooler (3):
Hood(s):
Duct(a)1:
Miscellaneous:
10
APPLIANCE:
Dryer(s):
Range(s):
Gas Log (a):
Wood Stove/
Solid Fuel:
Gas Water Heater (s):
11
UNIT HEATER(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
1000-175OM:
Other:
Pressure Vessel (cu. ft.):
15
COMPRESSOR/HP: Less than 3:
7
15:
15-30:
30-50:
50+:
16
GAS PIPING SYSTEM: Number of outlets:
17
HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18
TYPE FUEL SOURCE: Electric ❑ Gas ❑ 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