1984, 11-30 Permit App: 00003993 Insert . i
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Owner's Name (Last) (First) (M) Department Use Only
1
Hieronymus Rick ` Project No.
2 Project Address(Not Mailing Address) Space Zip
E 6805 14th
3 City/Community State Subdivji 'qn/Platla�/s`� AS
Spokane Wash l .�%"C1 ff(.tr ,4cff
4 Assessor Parcel No. / Lot Block
-7:11..e3:34/1 '' /PD`— - I I)(11' 67/2_.
16 Contractor Firm Name Street Address
Pleasant Prairie Farms Custom Mfg, Inc. E 7827 Bigelow Gulch
17 Zip City State Phone
99207-9698 Spokane Wash (509 )467 6760
18 Contact Person License No. Phone if different than above
J. Gram low 223 01 Pleasi*229JE
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
15 Describe Work: Installed Custom Insert Customer responsible ror beartn
New ❑ Addition/Alteration ❑ Replace/Repair ❑
10 Applicant Name Street Address
11 Zip City State Phone
( )
* 1 *
8 VENT: Fan(s): Evan Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
10 APPLIANCE: Wood Stove/
Dryer(s): I Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
I— 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
Z
W
a12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
jl
0
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
tL
0
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a
>I—
a 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
Z
Q
W 16 GAS PIPING SYSTEM:Number of outlets:
c0
2
J 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
Z
18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; Heat Pump
1* Number of separate zones for any heating, A/C or air handling system.
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.
SIGNATUR: OF , APPLICATION
OWNER O• �"` DATE //7 Leer J .g/