1985, 12-31 Permit App 00009272 Insert •
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
IProject# n
Owner's Name
Last First MI
Benedict George
Project Address(Street Name&Number)
S. 4229 Driftwood Dr.
City
State Subdivision/Plat Name
Spokane WA 99206
Lot I Block 'Plat#
Assessors Parcel#
I Address
Applicant
City
I State Zip Phone
Business Phone
Address
Contractor
Valley Fireplace 16610 E . Sprague - PO Box 553
City
State Zip Phone
Veradale WA 99037 922-2780
Contact License# Business Phone
VAULT 177 CG
Describe Work `!"a 30 \ Qc&.�tt l nhn(26cJL
Installation of .onvectort. ero clearance hearth ex ensilo c Hate/Ducts Miscellaneous
Fans Evaporative Cooler Hoods
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
yec, RPP above
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 15-3OHP 30-50HP 50+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10u, 00+BTU
Gas Fired Heating 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. 1 ,
SIGNATURE OF APPLICATION \ �Jl �
nrAiNFR • Ato DATE