1984, 11-23 Permit App: 00003514 Wood Stove 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
_ Gray Pat Project No.
2 Project Address(Not Mailing Address) Space Zip
6502 E . 15th 99212
3 City/Community State Subdivision/Plat Name
Spokane WA \J L y \J& 41U' Z'9 A-0/9
4 Assessor Parcel No. h�Q Lot Block
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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 woodstove, hearth, pipe
New ❑ Addition/Alteration ❑ Replace/Repair ❑
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): 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
a12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
0
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
U-
O
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
>-
I—
O 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
W 16 GAS PIPING SYSTEM:Number of outlets:
2
3 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
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18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; Oil ❑ ; Coal ❑ ; Wood C ; 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.
SIGNATURE OFC
3� ���Q APPLICATION
OWNER OR DATE
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