1986, 07-31 Permit App: 00012529 Wood Stove R '
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project# /2529
Owner's Name Last First MI y
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Project Address(Street Name&Number)
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City . i'' State Subdivision/Plat Name
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Assess.rs Parcel# Lot Block Plat#
Applicanl��
el .e /��'/ : Address 7 Q t
Cit ((//mss State , Zip Phone
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Business Phone
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Con o /l y L AA. Address
City
i /0 Ai; Statg n4 Zi �� Phone /e�et
Cont- t a/ (lam)•% fLiceensse# Business Phone
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Describe Work
542-
G�._lVG/JL7 6/
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
1
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
Compressor 0-3HP 3-15HP 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 to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
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OWNER
SIGNATURE
ATU E OF \ '' �z,c, DATE CATION? 5 r 1. --A,