1985, 10-18 Permit App: 00008176 WoodstoveMECHANICAL PERMIT APPLICATION WORK$WUUT
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 # e,(70, t7Y
Owner's Name Last First MI
RVSt.i a INS ke
Project Address (Street Name & Number)
S, J309 If re. f'1 0 o
City
itfoiria Se
State
Win
Subdivision/Plat Name
753 rs Parcel #
Lot
Block
Plat #
Applicant. ,I `'
t hi DK Mr de
Address
City
State i
Zip
Phone
Business Phone
Contractor
Ate Redk Coit►n,►„
Address
_of7ot AA /f *de /tat.
Cit
•t�.Kc
tate 0
GU
7
279,14 7
PhY
t 83 po�L
Cont t 1`% CGRoc 1S'iZr 3
Business
e
Describe Work
Fans
Evaporative Cooler
i
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel /Wood Stove
Air Handling Units
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
,
8+ Outlets
Gas Fired Heating System
1-100,000BTU
104.0;00+87U
SZ. D.o0
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