1985, 10-17 Permit App 00008447 Fireplace InsertMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project #
Owner's Name Last First MI
Parvey Dennis
Protect Address (Street Name & Number)
E. 9324 Xission
City
Spokane
State
GSA 991(06
Subdiv' ion/Plat Name
UPPOR UN;
Assessors Parcel #
175V-12--- 675S
Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
Valley Fireplace
Address
E. 16610 Sprague — PO Box 553
City
Veradale
State
WA
Zip
99037
Phone
922-2780
Contact
License#
VALLEF 177CG
Business Phone
Describe Work Installation of Olympic 3400 woodstove insert
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems!
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10,,,:,00+BTU
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 APPLICATION
OWNER OR � vut-L.; A aft i DATE 6 U /I