1985, 01-21 Permit App: 00003997 Insert MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) ���Ytt'(First) (M) Department Use Only
Bra nson u4etty K Project No.
2 Project Address(Not Mailing Address) Space Zip
S 3412 Sundown O'.
3 City/Community State Subdivision/Plat Name
Spokane, Washington re'?Cf/4o1r Lci6ieC
4 Assessor Parcel No. Lot Block
f/ -- i5/ 59q7
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 ( 509) 467 6760
18 Contact Person License No. Phone if different than above
J. B. Gramlow 223 01 Pleasi*229JE
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
15 Describe Work: Install Custom FP Insert. Customer responsible for Hearth Ext.
New ❑ Addition/Alteration ❑ Replace/Repair D f needed
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):
H- 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
W
2
a 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
LL
0
-
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
>I—
15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 30-50: 50+:
W 16 GAS PIPING SYSTEM:Number of outlets:
2
D 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
Z
18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; Oil D ; Coal ❑ ; Wood 0 ; 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 O ) � APPLICATION
OWNER OR DATE / " l_f