1986, 04-02 Permit App: 00010354 Fireplace InsertMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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 ORS
DATEICATION c4 /Q 114
Project" J v ✓ cl'
Owner's Name Last First MI I
Burns Eddie
Project Address (Street Name & Number)
S. 2506 Sunrise
City
Spokane
-State
WA 99206
Subdivision/ Plat Name
Assessors Parcel 0
Lot
Block
Plat k
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
Valley Fi -glace
Address
_ E. 16610 Sprague - Po Box 553
City
Ve rada l e
State
WA
Zip
99_037
Phone
922..2760
Contact
License N
VALLEF 177 CG
Business Phone
Describe Work
Installation of Arrow 1600 into masonary fireplace with positive connection cu om r rg
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous � "r "`�
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
yes, see above
Air Handling Units
0.10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10x,;,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.
SIGNATURE OF
OWNER ORS
DATEICATION c4 /Q 114