1985, 12-09 Permit App: 00009123 Insert _ !v/'7"/ __ I i 0
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# 1 I 2
Owner's Name Last First MI G
Freatman Robert
Project Address(Street Name&Number)
12606 E. Valley Way
City State Subdivision/Plat Name
Spokane, WA 99216 O1WION1 )
Assessors P r el# Lot 6 Block I ;-2 Plat#
I ; — L'7c 7
Applicant Address
City State Zip Phone
Business Phone
Contractor Address
Valley Fireplace E,, 16610 Sualgup — pn Rox 553
City State Zip Phone
Veradale WA 99037 926-2780
Contact License# Business Phone
VALLEF 177CG
Describe Work
Installation of Sweethome extended insert wood stove, pipe liner
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
yes, see above
0 10,000 CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
0-3H P 3-15H P 15-30H P 30-50H P 50+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10v,.: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 APPLICATION r
OWNER OR c� �� + _ G1' .DATE 9