1986, 10-03 Permit App: 00013586 WoodstoveMECHANICAL 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 •
1",m Jet APPLICATION (0 f 3 j (�'D
DATE
Project # 13 5-S/
(�
Owner's Name Last First MI
' ,t177//4"--P_f7 L Oc12/2 C/
Project Address (Street Name & Number)
J R i
S . beeves
Cityty
�o IGQrv'
State n
Vv/ A
Subdivision / Plat Name
As1 rs Parcel #
Lot
Block
Plat #
Applicant
U A /),y --if L., A e -e.2
Address
(. /64 id Ser a ve/
City I Stat
(fo�'peub 1 -(JR
Zip
99o3 7
Phone (J
�aD-.D79d
Business Phone
Contractor
(/14LtL 1 J f-ep 4e e..)
Address
, /6 4i6 Spc,v
City
t1 erada/ t✓
State
w
Zip
9133 7
Phone O
2 7ko
iontact
-11A
License #
-L, & /77
Business Phone
Describe Work CT y 1915 C, An s -L- 4 eo c l -k u c X(.& D rx C ID u. .4\, //14.7 T em 6rn- +0.4 -?3h /) y}. c1 vtYtAhAJ (
v
Q
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
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
10u,. 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 •
1",m Jet APPLICATION (0 f 3 j (�'D
DATE