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1987, 10-21 Permit App: 87003554 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. SIGNATREOWNERUOROFirt 1�% �i"``�""/ DATE CATIONote f1 Project # Owner's Name Last .464,Firstvitli MI C rbor Project Address (Street Name & Number) s 15 I Z S �©ck `7A City State Y Leacattle. W A Subdivision/Plat Name K bi-Ci4 fclbp 15 c.+ 11 rxs >v` Assessors Parcel # .2...44$ - D -1 13 1L/, Lot Block Plat M Applicant ®abe,nk i,e ct OA w,h rV i o� Address l 6 30o-7 ProV t _e, City State Zip ? '"T Phone -'7tace3 x'83 Business Phhotn�e� / - _ Contractor r© Address City " C. State ,/,./6411."--- Zip Phone SE91...--YK..Ci Contact r&r k L (.0 v License # A SG /33J Busines;Shon ' Describe Work I rl ll cohcY\ a LOGOAS'b v'e— 4' SioNie (340e--- 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 Gas Fired Heating System 1-100,0008TV 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. SIGNATREOWNERUOROFirt 1�% �i"``�""/ DATE CATIONote f1