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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•