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1986, 10-29 Permit App: 00013904 Woodstove
MECHANICAL 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 0_/2,.ze OWNER OR DATE APPLICATION n�O C S Project # '43/'ik `7�JJ Owner's Name Last First MI \Jot"/ ke I-Da.rr2G( 4 Project Address (Street Name & Number) .F.47st- /39/5- /14q//K A 1.--e- qx 3,70/4 I State 1474 Subdivision/ Plat Name lX 0 v62A Ac z S Assesso1� -Z - 14-05 Lot �. BlockZ lo .1 PI i N�� 4S Applicant parr-ei% 2 . Ja I -1%-e_ Address -a 5 f 139./6—//44'1/4A4t City cra k4,1_, -e_ State 1.74 Zip f9v.2/ 6�� Phone g. -,v-- 3 8- 6' Business Phone ,91.8-0d0 Contractor Address City State Zip Phone Contact License # Business Phone Describe Work Fans Evaporative Cooler tis 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 -31 -IP 3-15HP 1530HP 30-50HP 50+ HP Gas Piping 1-5Outlets - 6+ Outlets Gas Fired Heating System 1-100,000BTU 10v,,A0+BTU `J•©® 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 0_/2,.ze OWNER OR DATE APPLICATION n�O C S