1986, 12-12 Permit App: 87000153 Wood StoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
40 X/9R
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
OWNER OR
APPLICATION
DATE 12/1=-4 ?(0
Project# X/ rel n
Owner's Name Last First MI
browN1 John k,
Project Address (Street Name & Number
5, 3811 roto PCO±
City
SPokfrJE)
State
u,OC4N
Subdivision/ Plat Name
ch€5*e.rf1YeId,
(Ica (0-1n-
Assesaora Parcel # 3354.2 _ ")--E305
Lot`ot 5
Blockal o�_
Plat #
Applicant
5A(v�lo
J
Address
City
State
Zip
Phone
Business Phone ,/
5
Contractor/ A f rl� 1� F,
J f.-^� FI.
o o
Address
City
State
Zip
Phone -
Contact
License #
Business Phone
Describe Work sit • 1.y� _�.] b_i n,co 5voVO _
JI^' `f
(`ql `J \/Electric
Fans
Evaporative Cooler
rok,
Hoods
(vonto,
Furnace/ Ducts
fnCYR-e.,
Miscellaneous
(VSYQ-,
Dry r
�
Range
(��
Gas Log
���
Gas Water Htr.
�a
Solid Fuel/ Woad Stove
X
Air Handling Units
0-10,000 CFM
\ '�
ilk
10,000+ CFM
n
^�l^ ---Q—(2----
`\-501-11,000yIT
Refrigeration
Refrigeration Systems/
Heat Pumps (BTU) k�/
1-100M
-`
101-500M
_�rl
x
1,001-17 M
Over 1750M
x
Compressor
0-3HP
X1-5
3-15HP /
15-30HP
X.6+Outlets
30.50HP �.
50-f- HP
Y
Gas Piping
X -
Outlets
Gas Fired Heating System\ /
Y
1-100,000BTU ��
10,,,;,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 OF
OWNER OR
APPLICATION
DATE 12/1=-4 ?(0