1985, 10-24 Permit App: 00008283 Wood Stove r
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MECHANICAL PERMIT APPLICATION WORK$WIIIIT S-F2
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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. —�'mOur \kck�-�r '' Project# E"E3
Owner's Name Last , Vrst MI
WciOt:R . k-)‘\ 0(fL,c>
Project Address(Street Name&Numbe
CitState Subd4rLLf1 &w
ion/Plat Name
-slot, Lc'� c�51, sr
Assebbors Parcel# Lot Block, Plat#
27593 ' ' ogi6 _ /(e- _ �'
Appliciant Address ,
IS4+iir r, AemoLur #agoS 0 sk)j rt= ,,c_)
City State Zip Phone
s po u3 ac I. 9 g 2 f (o qa 1:-.,- S_93 0
U 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
Wfrac S ±o )'
0-10,000 CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ ' 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
0-3H P 3-15H P 15-30H P 30-50H P 50+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10,,:.00+BTU
Gas Fired Heating System
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 OFAPPLICATION � y / -/J- --
OWNER OR '; �
r�� a�J '771-6)-C-e/L DATE 2 '- -&.