1986, 11-10 Permit App: 00014076 Wood StoveMECHANICAL 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 OF
APPLICATION
OWNER OR DATE
Project If /, .nth
Owner's Name Last First MI
Th l CH (-- A-0€ DI
Project Address (Street Name 8 Number)
Al, r:2- oil L Atir2A i0
City,
State
Subdivision/Plat Name
Assessors Parcel
Lot
Block
Plat ft
Applicant
-05 A -i(1/14 .
Address
S G> ./..2- A �, 2 _)
City
SPOkil1.\4
State
trJA
Zip
C2J.3-/(v
Phone
Q ? X33
Business Phone
9 nt2-33/9
Contractor
Address
City
State
Zip
Phone
Contact
Licensee
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuei{Wood Stove
Air Handling Unite
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
10.),.-.,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 OF
APPLICATION
OWNER OR DATE