1984, 09-24 Permit App: 00002539 Woodstoveqct ,->r -:2<;
vy ,
MECHANICAL PERMIT APPLICATION WORKSHEET
Ju PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
t
Owner a Name ( O -
(Flrat
0.
IMI
Cap«tmpnt Use Only
viol«t No.
z
NajM AEar«slrvot MailinO Adar«s)
O
Ga. DO
3
Lityl Community
Slate
9ubdlvlelmlPlel Neme
a
Parrel No.
Lot
BI«x
10
Canir«ip Firm Name
Street Ad&NA
17
210
City
State
Phone
1 1
10
Cant«t Parent
U.nee NO.
Phone 11 different than above
e
O W/ApMt 0l different than xt elNne)
BuaineM AxIc.
9
zip
City
Siete
Phone
f I
15
L«arlbe Work:
New 0
Addition/Alteration D Popl«w/Wpalr ❑
10
AIZName
A
Street Add.
11 DO
OR
stee Rlane
�J r - CJ - y
0
VENT: Fan(sY
EveD G001«IeI:
Hoode):
Dunt(,) 1:
Mhe"Nian«ue:
10
APPLIANCE
O'yarle):
Ran9ela):
Om
Lai
ISaid
I Word St..,
Fuel:
Gaswat«Heal«0):
11
UNIT HEATER(S): we Mmmt: Y
Flop: (�&
N
Suep,nded: Y N
12
AIRHANDLING: 10,(00 CFM Or I.:
I
Mpeftald.OWCFM:
13
REFRIG SYSTEM BTU: 1-1001:
10O500M:
500.100OM:
td
1001;
GNY:
Preaeure V., (m. X.):
15
COMPRESSOR)HP: L. than 3:
3-15:
1S :
3050:
W+;
15
GAS PIPING SYSTEM: Numberal outlets:
P
HEATING SYSTEM: 1-100,000 BTU:
100,001+BTU:
10
TYPE FUEL SOURCE: EI.4c D
Gas D Off
❑
Coal ❑ vead )4; SaW D
19
TYPEOISTRIBOTION: FO¢,d Al, ❑
PadlaM ❑;
HM 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.
SIGNATUREOF \ APPLICATION
OWNER OR Y�C�k,.l� .DATE