Loading...
1985, 09-04 Permit App: 00007249 WoodstoveMECHANICAL 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. SIGNATREOWNERUOROFr��/� ���77/1 DATE CATION �y— '14eFr,. Project # -72 `T9 Owner's Name f�%L'asstt First MI % ^ Project Address (Street Name & Number) /47r-- 5, Ale -c-6, -- City p�X,4-y,E State A- 997-1 Subdivv n/Plat Name UPPO RTt ury rr/ l ER,�AC�E Assessors Parcel #2-15 / / — /743 C/L Lot S Block 3 Plat # Applicant Address City I State Zip Phone Business Phone Contractor Address City State Zip Phone Contact License # Business Phone Describe Work Fans Evaporative Cooler Hoods ElectricFurnace/Ducts Miscellaneous Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove Air Handling Units 0-10,000CFM 10,000+ CFM Refrigeration Systema/ Heat Pumps (BTU) 1-100M 101-500M 501-1,000M 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 15 -301 -IP 30-50HP 50+HP Gas Piping 1-5 Outlets 6+ Outlets Gas Fired Heating System 1-100,000BTU 10u,4300+ 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. SIGNATREOWNERUOROFr��/� ���77/1 DATE CATION �y— '14eFr,.