1985, 12-19 Permit App: 00009203 Wood Stove - ,
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# ('9�
Owner's Name jj�� y i Last Ftrsf / Ml
(i)'0. '- -P r C- /7) /CI1:CfEms:
Project Address(Street Name&Number)
' , 13 07 y'yjc�
( 'ck n r-"=
4 -C. -
City !, ft--(._ State,l c.„( , Subdiv lonl� Name
S
Assessors Parcel# /66 ` /�6� Lot Block / Plat#
Applicant dceJ
n / Address
City State , Zip Phone
SA0k Cc/\ 92Ut Rz SZ. a
Business Phone S3 Y 6 O C
Contractor Address
SC( //L,C.— _
City State Zip Phone
Contact License# Business Phone
Describe Work (-- i
� Oa - ' -ou- -
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 15-30H P 30-50H P 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10v,L00+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.
SIGNATOWNERUOROF//Z� f-�'�ej� 00c-4,-
J .DATE CATION /2// 9AFS