1984, 09-30 Permit App: 00002613 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
Fleming Curtis Project No.
2 Project Address(Not Mailing Address) Space Zip
E. 12702 Skyview 99216
3 City/Community State Subdivision/Plat Name
Spokane WA NSU, T-
4 1/1Assessor
Parcel3 / Lot 14No. Block
\
16 Contractor Firm Name Street Address
Valley Fireplace E. 16610 Sprague
17 Zip City State Phone
99037 Veradale WA (509 ) 922-2780
18 Contact Person License No. Phone if different than above
VALLEF 177CG
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
15 Describe Work: ins-s:nation of Convector I, pipe, he i tti
New ❑ Addition/Alteration ❑ Replace/Repair ❑
10 Applicant Name Street Address
11 Zip City State Phone
( )
w r
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
2
0_ 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
0
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
LL
0
14 1000-1750M: Other: Pressure Vessel(cu.ft.):
Ct.
I-
0 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
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 ❑ ; Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; Heat Pump f:
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 /1H---- APPLICATION
OWNER OR �: i (� � ��� . �> ,/1,4 1.��/. DATE ( 1