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1985, 09-24 Permit App: 00007664 Wood Stove
MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND -7 ea) AS Project# / 7 (�/ Owner's Name Last First MI !O7 RE----/-7-1 7— � i�K.45 r4‹ Project Address(Street Name&Number) 7flo5 . /© Cit State Subdivision/Plat Name moi. 99�.42... 4e.,'t 1)L /-4-?K Assessors Parcel# G J„� ` e7/g Lot ` Block Plat# Applicant r/1 (7 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.,,L00++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 OF 11110 / • ' APPLICATION' / i � OWNER •• �"_J%/��-- • AC .DATE