1984, 10-04 Permit App: 00002752 Insert MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M) Department Use Only
Brewster Stee Project No.
2 Project Address(Not Mailing Address) Space Zip
E. 12015 - 6th 99206
3 City/Community I State I Subdon/Plat Name
Spokane WA I k 1 nf lao �f 0.4, /:_a /626
4 Assessor Parcel No. Lot Block
2/5V--/ - f3/c) 75
16 Contractor Firm Name Street Address
Valley Fireplace E. 16610 Sprague
17 Zip City State Phone
99037 Veradale WA (509 ) 922-2780
18 Contact Person License No. Phone if different than above
VALLEF 177CG
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
15 Describe Work: Installation of Convector II, insulated pipe, hearth
New ❑ Addition/Alteration 0 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: Wood Stove/
Dryer(s): I Range(s): Gas Log(s): Solid Fuel: I
1 Gas Water Heater(s):
1— 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
Z
W
2
a 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
O
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
LL
O
—
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
CL
I—
ZQ 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50;
50+:
W 16 GAS PIPING SYSTEM:Number of outlets:
m
2
J 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
Z /
18 TYPE FUEL SOURCE: Electric 0 ; Gas 0 ; Oil 0 ; Coal 0 ; Wood F3 Solar 0
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant 0 ; Heat Pump
1* Number of separate zones for any heating, A/C or air handling system. 2(.. t'-6
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 :' . — ----- l �� APPLICATION i ,
OWNER OR K.... :.)._ I�.s2-.,_k.4,-e, ISI _(4 `1^�--t.l:i l
' DATE ( D ' �` 1