1985, 09-30 Permit App: 00007764 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 � ICATlON
n
OWNER R �iG�G� --d�1
Project N
Owner's Name last
First
MI
Project Address (Street Name & Number)
Stu
City J
5 C9 K n1
State
Gv f�-
Subdivision/Plat Name
Assessors Parcell!
Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
J
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License f
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnaos/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Unita
0.10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100101
101-W04
501-1,000M
1,001-1750M
Over 1750M
Compressor
7�p
3-15HP
15-30HP
30-50HP
50+ HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000STU
10u,"+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 � ICATlON
n
OWNER R �iG�G� --d�1