1980, 10-03 Permit App: 00008101 Insert MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# g//-ti
Owner's Name Last First MI �J((
Seyboth Don LQ'
Project Address(Street Name&Number)
E. 17706 — 6th / /_17f
City State Subdivision/Plat Name
Greenacres WA 99016
Assessors Parcel# /Q55- Cf7 '7 01 ty Lot Block Plat#
v �
Applicant Address
City State Zip Phone
Business Phone
Contractor Address
Valley Fireplace E. 16610 Sprague — PO Box 553
City State Zip Phone
Veradale WA 99037 922-2780
Contact License# Business Phone
VALLEF 177CG
DescribeWork Installation of Super Heat woodstove insert
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
I Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
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
0-3HP 3-15HP 15-30H P 30-50H P 50+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping
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.
SIGNATOWNERURE OROF Imo .!17-P,--1-4" --N��= • r,^Ct(2"( %' APPLICATION �, J
DATE