1985, 12-20 Permit App: 00009209 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 Osi7.°
OWNER OR
APPLICATION
DATE
Project # q.2/ 0
Owner's Name;:.?Last � MI
Project Address (Street Nammber)
3/vJI .
City
State j?&_____
Su' = ision 1 Plat Name
rs Parcel #
Lot
Block
Plat #
cant
,7/--------
1l
/� i
Address
/J
City
Stat
0 .
Zip
f9.3. 7
Phone
i:, -1/4 /7
Business Phone
Contractor /
c i -tet.! v d ---.e.----
Address
Clty
i
at /4.Zfp,Z
Phone 727
License #
I. Gr/,E = s7 .E 73= /9 9 /-
Business Phone
-^V.,.3 -moo / 7
ri �,
Fans
Evaporative
Hstfds
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fyel / W Stove
Air Handling Unita
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
1-100,000BTU
10u,;,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 Osi7.°
OWNER OR
APPLICATION
DATE