2005, 08-31 Permit App 05003169 Gas Insert'M'
Community De�veloppmment
Mechanical Permit
SITE ADDRESS
Permit Center ce— S i W 9
11707 E Sprague Ave, Suite 106 PERMIT NUMBER:
Spokane Valley, WA 99206
(509x688-0036 FAX: (509x.88-0037 44^L' PERMIT FEE:
%�w sookanevallev ore com
Annlication ❑ Commercial ❑ Residential
Building owner -
Name: "'
Phone:
— C Fax
Address:
City State Zip i
Contractor
Name:
Phone:
Fax:
Address:
City State Zi
License No:
City Business License No:
Contact
Name:
Phone:
AUTHORIZED SIGNATURE: /�t'� ^� L(fi REVISED&2N05