1987, 01-21 Permit App: 87000147 Wood Stove MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project
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„.l Owner's Name Last dr First MI
Project Address(Street Name&Number)
City E /93/2 /Yet (-ex
(/Ja r/ Su ionlPlat Name
C'7it..e,2A a.c tki A- 9'. )&'�. -rN2i S VA.CL f Vw sm
Assessors Parcel M1 / 55 3 _ /20 3 Lot 3 Block 1.... Plat#/,/-1,cRi
Applicant /� Address
Get t i'z AA rdi €/ .31 2- (dot-Qe, c,J a7
�City State Zip9 9 ^ /�' Phone s --p J 7 J
rJ/LP�-�2 6.,,,„..._ `/
Business Phone
Contractor Address
City State Zip Phone
Contact License M Business Phone
Describe Work /'
Int )t/Q Ge
.7 in/i-e--
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000CFM 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
Gas Piping 1-5 Outlets 6+Outlets
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Gas Fired Heating System 1-100,000BTU 10u,:A0+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.
SIGNATURE OF APPLICATION
OWNER OR .DATE