1984, 04-02 Permit App: 00004741 Wood StoveMECHANICAL PERMIT APPLICATION WORKSHEET
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.
OWNERUORO
F�Gt-trerrue0 _AS
DATECATIOf� f e/
Project 6 ct, t7 //
Owner's Name Last First MI
.--CC? (I e RC J mrin/C
Project Address (Street Name & Number
76/4' / CQt('lis IC
City
SpokanJC
State
LA)//t
Subdivision/Plat Name
AssessorsP2-')-22 I _q
J
v L
Lot
Block
Plat p
Applicant
Roy 114 CPI d 50.11 e
Add ess
76 /e/ Cc r 11's. (c
City
SIC) kvNp
State
wk1
Zip
99.Atat
Phone
9o'8.789Ci
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License 6
Beninese Phone
Describe Work
V( Oc.70 SZoc w/ `Inpre-c> N.) '-( GNtvnIN, e /
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts -
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
-Solidfuel/Wood Stove
7
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
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1 -100,000B -1V
1O,,d00+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.
OWNERUORO
F�Gt-trerrue0 _AS
DATECATIOf� f e/