1986, 04-25 Permit App: 00010715 WoodstoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
AtaRi
/Gid x130
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
ak Li, A
,As�,e.�i. APPLICATION
Project# /6115
Owner's Name Last
>> ,RAM E e ybst h 64 MI n
Project Address (Street Name & Number) S oaf 1+ a 0C' 0 it tx I' N rnoo6
City /�
(lam 0 AikANG
State
WAI
Subdiv nl Plat Name /
cliEs?m 11iLW rs
Assessarcel #� / — L `�
yL
Lot
Biock_ _
Z
Plat N
Applicant
Address
City
State
Zip
r
Phone
Business 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 Water Htr.
Solid Fuel /Wood Stove
1
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
r10v,,
Gas Fired Heating System
1-100,000BTU
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
ak Li, A
,As�,e.�i. APPLICATION