1986, 10-14 Permit App: 00013594 Wood Stove -,
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# 1 5-01i
Owner's Name Laet First MI
Project Address(Street Name&Number)
5- S// o(4 . 7`/9
City State Subdivision/Plat Name
�/2 '
-
Assessors Parcel# Lot Block Plat#
Appi antAddress
o 4--?z.77 U - � A/Xd J/G 707c ) /J/ '/,s/
City State Zip Phone
K/o"ir/17 4/6— orf 7907/r ?— CZ
Business Phone
(_,, O,7177L /ys ove-
Contractor Address
City State Zip Phone
Contact License# Business Phone
Describe Work
w1n r?:N
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/ 1-103M 101-500M 501-1,000M
Heat Pumps(BTU)
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