1986, 11-14 Permit App: 00014198 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
SIGNATUREOF
At. /. I, n an J.A.
APPLICATION
FS S•
Project" / til `l.8
Owner's Name Last First MI
S CIVAUtittd zir , •re M'
Project Address (Street Name & Number)
a 2266 Sosffl
4c .'1G^•
City
l/elet r kt4.
State
6t)/4 -Che £9"i
Subdivision/Plat Name
&dL v 44h.AV
Assessors Parcel fi2 _ _
jqC
Lot
Blocki.,
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
Air 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
1530HP
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
SIGNATUREOF
At. /. I, n an J.A.
APPLICATION
FS S•