1987, 11-27 Permit App: 87004081 Pellet 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 qr 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
OWNER OR /
APPLICATION
PATE //'? 7- (5-7
Project 1
Owner's NameLeet First MI
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Project Address (Street Name & Number)
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City
State
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Subdivision/ Plat Name /� /
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Block
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Applicant
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Address /
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State
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Zip
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Phone
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Business Phone
Contractor / /
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City
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State
Zip
Phone
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Business Phots
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1,67120i---073,
ContactCigna /r
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Describe Work
Fans
071e
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Fangs
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
L.----
Air Handling Units 1010,000 CFM
.Z/
J 10,000+ CFM
Refrigeration Systems/
Hest Pumps (BTU)
1 1-100M
101-SOOM I
501-1,000M
1,001-1750M
Over 1750M
Compressor
1 0-3HP
3-15HP 1
15-30HP
30.50HP
I 50+ HP
Gas as Piping
0+ Outlets
Gas Fired Heating System
1-100,0008TU
1114.300+8TU
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 qr 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
OWNER OR /
APPLICATION
PATE //'? 7- (5-7