1986, 07-07 Permit App: 00011983 ACECFrIANICA: PERM' TIPPLIoWtiON :WORKSHEET
L
certify that the above inforniailblv,iii:iubm'itted and correct and further, agree that all pro-
visions of laws and ordinances- goveenIng this type of. work, IncludIng'InspectIon requirements, will be com-
plied with whether specified hereinor not. The granting' of -a,permit does not presume to give authority to
iolate or cancel the provisions of:any state of -local laWs:regdiating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION
DATE
Project 1 / P f'7
NarneLast First ' , • ' ' . MI
/17/Y7 -2./9e'<_ ,i74/v,eir-16' . C
pr,,ddr... (Street Name & Number) '
- /3 4/// A -300/V-
,.,
State
Sutxlivls /Plat Name
VA l_i__ Vieto
As,--ior5 Parcel.//55 . '
ti
..1-0102-- .
Lot
,
Block KM 0
1_
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Al 0',.lint '•, .
. . . .
. : .
Address .'
my [State
*5-73
! • - -.. .,:"47,.4,-;...f4-4:: '
! . (124,1g 7,:; ''i::i,:•,'... , „..
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7.*- • ,,ee,444( 97V‘
1 _.5/1401,47.-
State -Phoni
,
, ..S" ,,S-":---,•"7//
I C-nntact
L L.rs42/114/71/1/07;0!fr14//f
License 0
Badness Phone
! crtbe Work
,1,/ .,,f4,,4/-„ef /7360.-feA .
,rt,s
Evaporative Gooier
Hoods
Electric Furnace/ bucts
Miscellaneous
I-....
Range
Gas Water Htr,
Solid Fuel/Wood Stove
iandiing Units
0-10,000 CFM .
10,003+ CFM
! i.tt.ttrigeration Systems/
-twit Puml (BTU)
1 -1 WM
2r^1474/e7)(/4/i, *-.2-// . .
. .141-500M
5O1 -1,000M
1,001-1750M
. ,:,:L*,':•"
Over 1750M
-,H,:,' , , 7, , - -,
Tir,,Dr8ssor
0 -3I -4P ,,,
3-15HP '
15-30HP
30-50HP 150+ HP
--r
i ,+.9 HICIIri()
1-5 Outlets
e e Outlets
Heating System
1-100,0008TU -
10v0:00 +BTU .
2 1//7
1
. ,
. ,
L
certify that the above inforniailblv,iii:iubm'itted and correct and further, agree that all pro-
visions of laws and ordinances- goveenIng this type of. work, IncludIng'InspectIon requirements, will be com-
plied with whether specified hereinor not. The granting' of -a,permit does not presume to give authority to
iolate or cancel the provisions of:any state of -local laWs:regdiating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION
DATE