1985, 09-25 Permit App: 00007700 Wood Stove, Chimney •
MECHANICAL PERMIT APPLICATION WORK$HEIIT
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# 7700
Owner's Name Last First MI
",1, 1 GA/Efi-- E!-ETT" ,L >
Project Address(Street Name&Number)
City State Subdiv' ' n/Plat Name
gPo �,�� l,�}�- �'PP
Assessors Parcel 41/ / — /6(011
Lot Block Plat#
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
0-10,000 CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
0-3HP 3-15HP 15-30HP 30-50HP 50+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10,,,:00+BTU
Gas Fired Heating 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.
SIGNATURE OFj � APPLICATION S._ &S.--
OWNER OR e_-c,�..e�:c.1✓ ln./ .DATE