1984, 10-27 Permit App: 00003126 Fireplace Insert*
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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) (M)
Dunbrasky Ronald
Department Use Only
Project No. '+j vz,(,,
2 Project Address (Not Mailing Address) Space Zip
S. 4137 Sundown Drive 99206
_
3 City/Community
Spokane
State
WA
Subdivision/Plat Name
l9 t2 cLS T At EA Doc,. 4
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4 Assessor Parcel No.
'33 543 o 2--d1
Lot Block
—/..,__
16 Contractor Firm Name
Valley Fireplace
Street Address
E. 16610 Sprague
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 61 above)
Business
Address
9 Zip
City -
State
Phone
( )
15 Describe Work: Install Lope Plush insert with positive
New ❑ Addition/Alteration ❑
connection
Replace/Repair 0
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:
Dryer(s): I
Range s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(S): Wali 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 1000-1750M:
Other:
Pressure Vessel (cu. t.):
15 COMPRESSOR/HP: Less than 3:
3-15:
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 0 ; Gas 0 ; Oil 0 ; Coal 0 ;* Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; 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
OWNER OR
Lin
APPLICATION
DATE
107g7/f1