1985, 11-25 Permit App: 00008914 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.
SIGNATURE OF
1 to/A1C
APPLICATION
r% A TG
Project # . 3 q J 1:
YT
Owner's Name Last First MI
Cr, Z. -Se -7u .7vAd- 6;17,4 1%_
Project Address (Street Name & Number)
3s 13 S, itP 6- 1 t
City___State
Po,Cj4N&
w
Subdivision/Plat Name
Assessors Parcel #
Lot
Block
Plat #
Applicant
K��tie /2 62Lr56--r7v
Address
3873 S, ear 2),/ 2,
City 5PO J� 1 State w 4
Zip Qeiz c(,
Phone 9' Z 9- 7
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work
woo 2 5To vE / A>5�/9//Abe, Ai y—,e U&--
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/
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
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10v,.A0+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
1 to/A1C
APPLICATION
r% A TG