1985, 03-08 Permit App 00004450 WoodstoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Department Use Only
1 Owner's Name (Last) (First)
Rutter .l lm Project No.
Zip
2 Project Address (Not Mailing Address) Space
99206
E. 10405 Ferret
3 City/Community
Spokane
State
WA
Subdivision/Plat Name
_ /(er /S- Add
4 Assessor Parcel No.
Lot
Block
Lt ` /,..
16 Contractor Firm Name
Valley Fireplace
Street Address
E. 16610 Sprague
17 Zip
99037
City
Veradale
State
WA
Phone
( 509) 922-2780
18 Contact Person
License No.
VALLEF 177CG
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business
Address
9 Zip
City
State
Phone
( 1
15 Describework:Installation of Convector IIR woodstove, some pipe
New E AddltionfAlteration n Replace/Repair _
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( 1
8 VENT: Fan(s):
Evap Cooler(s):
Hood(s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
Range(s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
- 11 UNIT HEATER(S): Wall Mount: Y N
Floor: Y N
Suspended: Y N
J
12 AIR HANDLING: 10,000 CFM or less:
More than 10,000 CFM:
)
)
J 13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
J 14 1000-1750M:
Other:
Pressure Vessel (cu. t.):
15 COMPRESSOR/HP: Less than 3:
3-15:
15-30:
30-50:
50+:
t
j 16 GAS PIPING SYSTEM: Number of outlets:
m
7 17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric 1 Gas Fl ; Oil ❑ ; Coal ❑ ; Wood C ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air _ Radiant El ; 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 OF 0
OWNER OR
APPLICATION
DATE
iq (