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1986, 12-04 Permit App: 00014419 Wood Stove
MECHANICAL 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. SIGNATURE OWNER APPLICATION DATE t2— Li ( -. -e Project# `./.%,q 1�-� Owner's Name Last F Fat MI 14C.S ;,/J G �/ -Pe 2 2y Project Address�\ (Street Name & Number J I V R I S t-/\(T"Cr? ILO - Clty cco0K , State ti,k) • Subdivision/Plat Name �k2ia A -Vc--. �0_ Assessors Parcel # C-1 642-©9C�2 Lot Block - i 7-21 Plat # Applicant AAA_ Address City State Zip Phone Business Phone Contractor SONQ. qc CO,-STL C C Address jciLj'2 S (rr-T(r° Q1t<- "V. City Co-,exz-;— State LJ - Zip CPIoncc Phone 467--7ir67 - 1-(c-? -gvd6 Contact 0141 :—mac R License # S©fQ t22( CC t E. ( k Al Business Phone Describe Work .fl nt& t( t.anrxt Stnoe Dfc1ccc: oL old%rte,, kl-t'N) Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous Dryer Range Gas Log Gas Water Htr. 1 Solid Sto Air Handling Units 0-10,000CFM \( --- 10,000+SFS 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 -FHP Gas Piping 1-5 Outlets 6+ Outlets Gas Fired Heating System 1-100,000BTU 1W,: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 OWNER APPLICATION DATE t2— Li ( -. -e