1982, 11-08 Permit App: 00008635 WoodstoveMECHANICAL 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 Off-' �� APPLICATION
OWNER OR !til i,��l�%' /,L__zt- DATE ��'�
G
Project #
Owner's Name Last First MI
Project Address (Street Name & Number)
(( j
City
State
Subdivision/ Plat Name
to
Assessors Parcel#
Lot
Block
Plat #
44_ Z6
Applicant
Address
City
State Zip
Phone
`.��
�(\ � � ✓ �,: J ..� �`
`� �T - :ate r` ..,
Business Phone
Contractor
C00151�1_
Address
v<4
City
State Zlp
Phone
Contact,
License #
Business Phone
� ,
1. /`�-'�a' " �-
5CWQ L- CC -k 6 KpQ
TTlri�t.
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr. -
Solid Fu e W Stove
0-10, 000 CFM
10,000 FM
Air Handling Units
Refrigeration Systems/
1 -loom
101-500M
501-1, 000M
Heat Pumps (BTU)
1,001-1750M
Over 1750M
0-3H P
3-15H P15
-30H P
30-50H P
50 + HP
Compressor
-
1-50utlets
6+ Outlets
Gas Piping
1-100,000BTU
lW,X0+BTU
Gas Fired Heating System
V, �
3 I
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 Off-' �� APPLICATION
OWNER OR !til i,��l�%' /,L__zt- DATE ��'�
G