1985, 12-20 Permit App: 00009223 WoodstoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
SFS' / /5x 87
•
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 OFill � APPLICATION _
OWNER OR `�' t < DATE 1 L-
Project N 2
Owner's Name j l Last First MI
Project Address (Street Name & Number)
_ /., d 1e fK. )p ,
City r!
State
Subdivision/ Plat Name
HC BR K oo
As ParcelL�
Lot
Plat
2 --
#
Applicant
�. �[�Yi(1i�.
`� " s ' '
Addre
�
S./ / t� � � 41 ICA- ef" ,..6R..�
*n042 tc- 01-4-, F
State
(Ai A,
Zi
.0)-0 (...
Phone
q g 6 c4ff 2. 2---
Business Phone
'3 2_7 •a&& 7
Contractor
C'7,..-772-4 C��n1 -
Address
s..,4771 '
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work 5
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr. =t".)
Air Handling Units
0-10,000 CFM
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,, 00+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 OFill � APPLICATION _
OWNER OR `�' t < DATE 1 L-