1985, 10-23 Permit App: 00008262 Wood StoveMECHANICAL PERMIT APPLICATION WORMIEST
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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 F
OWNER OR
•
APPLICATION ���
DATE
Project # S Z 41,Zi
Owner's Name Last First MI
51innM9 0 A S ir4- 7v 4,1
Project Address (Street Name & Number)
N. 15/5 sink _('3, s)
City
5PQ.l?rl4 /V E
State
1/09'
Subdl ision/Plat Name
,(ti,t, to /ti fa (D IQ
Assessors Parcel #
Lot
Block
Plat #
Applicant
,"e&- t/ a S/ i/n m oNS
Address
AI. / 3/5 6EiNf %a.
City
SDoKprvE
State
W,4�
Zip
I
Phone O
9 —7197/
Business Phone WC123 — 3114a
Contractor
kA/emota A/
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work W
. d aD -74.a vs -N ESS AN i N S AFC770 N
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
15-30H P
30-50H P
50 + H P
Gas Piping
1-5 Outlets
6 + Outlets
Gas Fired Heating System
1-100,000BTU
10u, 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 F
OWNER OR
•
APPLICATION ���
DATE