1985, 10-22 Permit App: 00008225 Wood Stove MECHANICAL PERMIT APPLICATION WORK$YUT
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# re
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Owner's Name _ Last First MI
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Project Address(Street Name&Number)
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City L� State Subdivision/Plat Name
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Assessor�Parcel/,M54.2 )2 56 Lot Bloc Plat#
Applicant ZAddress
City State Zip Phone
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Business Phone
Contractor Address
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City State Zip Phone
P0r'cz. Y 1(1_ L-L) H ci92 6 (,-,
Contact License# Business Phone
Describe Work
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Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/W led Stove
0-10,000CFM 10,000+CFM `V/
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
0-3HP 3-15HP 15-30H P 30-50H P 50+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10u,:A0+BTU
Gas Fired Heating System
"Z.O .Oo
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