1986, 09-23 Permit App: 00013275 Wood Stove/5/1/-
< MECHANICAL
5/1/-
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
12l`/87
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 corn -
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 OF // //
OWNER ORat_l ✓c's'j„
APPLICATION
DATE
Project# 492.-75
Owner's Name. Last FirstMI
W (III Mmsaid `ora_ ti.)
Project Address (Street Name & Number
E 1139s >6g'ede,er'ci<
City
PbYtij"C
State a
)
Subdiv{crenl PName
I ---i tics ()-Ji
Assessors Parcel It
—/a/`i
Lot
't
Block
/
Plat#Ts{1-$`
Applicant
S fth-e A -s R- b6 if -e__
Address
City
State
Zip
Phone 9aa-3 33g
Business Phone
SR fiz-
Contractor
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work Q / t
1rus4 /� u-- Lioec0- Roei-i1 S`Dw2 -
CM. IA50NR-( C.bilW1N(y` v
Fans
Evaporative Cooler
Hoo s
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Hir
Solid Fueir/'�W�ood Stove
Xo ri$d-
Air Handling Units
0-10,000 CFM
10,000+ CFM V
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
1Q,,o00+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 corn -
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 OF // //
OWNER ORat_l ✓c's'j„
APPLICATION
DATE