1986, 11-06 Permit App: 00014040 Wood StoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project # /1/4
Owner's Nem i ^Last/ i,.First MI
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Proftltlress ( NamG & Number) 7313/CI
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State
1.
Subdivision) Plat Name
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Ass ors Parcel#/ — 6283
/253
Lot
Block
Plat It • s
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Applicant
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Address
City
State
Zip
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Busi ess Phone
Contractor
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range -
Gas Log
Gas Wate Htr.
Solid Fuel/Wood Stove
L
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 -151 -IP
15-30HP
30-50HP
504 -HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,OOOBTU
10u,:, W + BTU
7 l,00
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
APPLICATION
OWNER OR DATE