1984, 08-29 Permit App: 00002002 Woodstovew
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
466
1 Owner's Name (Last) /y� (First) \ (M)
t m 21 c k 1 f I �r\I .. nh n
Department Use Only
47_,002.....Ki
Project No. ......�..�.
2 Proj�ec( Address (Not
Mailing Address 99O/
(^�� Space Zip
(
7 ( h 12 I E'StateR
3 City/Community
FIEN3 c (2.1-75
WA.
Subdivision/ Plat Name
4 r Parcel No.
19.�s— a0 " ?' ` ,(i)
Lot
Block
,
16 Contractor Firm Name
Street Address
17 Zip
City
State
Phone
) q2'/-118(
Phone If dif Brent than above
18 Contact Person
License No.
8 Owner/Agent (If different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New le°.'..- Addition/Alteration
0 Replace/Repair 0
1 10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(s):
Hood(s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:I
Dryer(s): Range s):
Gas Log(s):
Wood Stove/
Solid Fuel: 1
Gas Water Heater(s):
11 UNIT HEATER(S): Wall Mount: Y N
Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or less:
More than 10,000 CFM:
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. ft.):
15 COMPRESSOR/ HP: Lessthan3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
/
18 TYPE FUEL SOURCE: Electric 0 ; Gas 0 ; 011 0 ; Coal 0 ; Wood f Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat Pump
1* Number of separate zones for any heating, A/C or air handling 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.
OWNER OR A a dALekiAPPLICATIONdy,s2Criday
DATE
SIGNATURE