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1988, 12-08 Permit App: 00014453 Woodstove
MECHANICAL 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 OWNER OR DATE APPLICATION /a�/Bl( Owner's"Name6/ f62 G Last ©iy/h Y/ CoFirst MI f'1 ils3 Number) Project Address (Street Name & NumbY SPo knA., C. to 972, City State Subdivision/ Plat Name Assessors Parcel N& _.3 --Ag '!7L SJ Lot Block Plat # Applicant Address City State Zip 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 Alr Handling Units 0-10,000CFM 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 OF OWNER OR DATE APPLICATION /a�/Bl(