1985, 12-04 Permit App: 00008999 Wood StoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
41(..
370
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 OR
APPLICATION /2 _‘7/ _&S
DATE
# % ��
Owner's Name Lest First MI
W,AQ
iir , „ r*• KcNNe'77f
Project Address (Street Name & Number
N 31o& Ea6E/t7au
City
SPpk t
State
[�A
Subtl%%��'�o��n,,/,,,Plat Name
URcg4Rf) 4vv
Assessors Parcel p>c11�Cf ' OVos
/
Lot S
Block 7
Plat #
Applicant
LA C4EPCE J l ,lea nip
Add ess
it) 3/o6 CDGCA7ZM
City
SPOKfr;J
State
w q- -
Zip
X1421 z
Phone(ZSR -323 t
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work
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
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,0000TU
l%,L00+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 OR
APPLICATION /2 _‘7/ _&S
DATE