1985, 12-31 Permit App: 00009276 Insert w
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
I Project# (i i7 7
Owner's Name Last 6
First MI
Dickenson Ernest
Project Address(Street Name&Number)
S. 1221 Woodlawn Rd.
City I State
Spokane Subdivision/Plat Name
WA 99216
Assessors Parcel#
Lot I Block I Plat#
Applicant
I Address
City I State
IZip I Phone
Business Phone
Contractor
Valley Fireplace Address
City
I State 16 610 F- Sp ragm. — p{) R mr 551
I Zip Phone
Vera dale Yds
Contact 99037 9222780
License# Business Phone
VALLEF 177 CG
Describe Work
Installation of Arrow 2200 wood stove insert wi h hearth extensio into masonary rhimn
Fans Evaporative Cooler
Hoods Electric Furnace/Ducts
Miscellaneous
Dryer Range Gas Log
Gas Water Htr. Solid Fuel/Wood Stove
10.10,000CFM Yes, see above
Air Handling Units 110,000+CFM
Refrigeration Systems/ 1-100M
Heat Pumps(BTU) 101-500M 1501-1,000M
1,001-1750M Over 1750M
Compressor 10.3HP 3-15HP 115 30HP
30-50HP I50+HP
Gas Piping 1-5 Outlets 6+Outlets
Gas Fired Heating System 1-100,000BTU 10�, 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 (2----1---------" f
OWNER OR x ! APPLICATION I
" "'�' .DATE �"