1986, 11-14 Permit App: 00014178 Wood Stove MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# /l/`-,-
Owner's Name / L2/$J�t/ �/Fiir,��4St /M'I
�'f.'��K�4 11x -
Project Address(Street NameNumber)
7
City State Su nlPlat Name
'-----:-7) Curl-e '( �t� a Ake AvE PGP r
Assessors Parcel# b-7 f 2 250 ' Lot Block Plat#� -�
Gb0 /�
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/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor 0-3HP 3-151-IP 15-30HP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10v,;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 tRi,
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
•
SIGNATURE OF � �.,4��/ !� APPLICATION
OWNER OR `��� .. /\ .DATE It- 11-1 -4