HomeMy WebLinkAbout1986, 04-24 Permit App: 00010728 Wood Stove •
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project# /D—1/'
Owner's Name �qt t 4� ".6F4 El .
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Project Address(Street Na &Number)
, y521 l' i
ity ' •ate Subdivision/Plat Name
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Assessors Parcel# Lot Block Plat#
15514- iI
Applicant Address
dt Pi tv/Claws pl c... 7 fLci j:/3s-?4 -6/400+
7
City 1 State Zip Phone
*six?tik WA_ 99z/4 wet- 7L74,
Business Phone
9?8 - g7
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 Fu Stove
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
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10k,,;,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. i9i4A
-J../.4.-144-k-
SIGNATURE OF - "' ` APPLICATION 9 �4
OWNER iff'4,) .DATE — G