1986, 06-11 permit App: 00012642 WoodstoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Ac ationtoJ
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 n !—`lam �J APPLICATION
OWNER OR G Com. DATE A
Project # I • i F /Z
Owner's Name Last �FirstI
forSy --1--hrh c _fiAfIes 14
Name Project Address (Street & Number)
.21..s - / J . Lor) 6- _
City
(7-T ° en 48 R.e S
State
W A
Su on/Plat Name
� QBliJ 4t Ae.
Assessors Parcel # te5-5-g mf40 46
Lot /
Block / 8
Plat #
Applicant
uptite,?) • l=t rt/J1Ae
Address
P. a , Q by 56-3
City
iJPrA4AI le_
State
LAiA
Zip
899037
Phone
9aa- 'lga
Business Phone
Contractor
V i:k1—L'Q-Ll r-:l2e,pL-AL '0)
Address
P O. Sox g 3
City /
(/erig c fe
State
(A)Pr
Zip
9503'7
Phone
2D ---D-720
Contact
License #
V 14 Li- --F- / 7 7e 6 -
Business Phone
Describe Work C11.4.‹/Zel2 /" f.esponsi¢/moidDe- ,3h.ei/d.i's -f Zoo,- ,30iStS ,
. LS I -A 1 / 10.5 , 5-6 D Fre-e ,S' -'A r)d ,n j 5 +,ef oe coii--j /rte //mete.
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000CFM
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 n !—`lam �J APPLICATION
OWNER OR G Com. DATE A