1986, 10-14 Permit App: 00014187 Pellet Stove i
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MECHANICAL PMMIT APPLICATION WORKSHEET
. PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
aueelfzr L Project# s 'g 7
Owner's Name / Last F'st Ml [
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Project Address(Street Name&Number)
/1? 1 f "77' / — 'CI_ -'C---' - • 1rtO i j •- iv/
City State Subdiv' 'on/Plat Name
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Asses rs Parcel# 235'L4— / 5oo i Lot / Block Plat# �+��
• licant �/—�'---J-�' Address
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City z StateZip Phone
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Business Phone
(599tractorAddress
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City State � �� Zip Phone
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ntac License# Business Phone
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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
Compressor 0-3HP 3-15HP 15-3OHP 30-5OHP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10,,,L00+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.
SIGNATURE OFf APPLICATION T-
OWNER OR/ , DATE //`�.M/16/,6'