1986, 12-31 Permit App: 87000125 Wood Stove A
' ' " MECHANICAL PERMIT APPLICATION WORKSHEET
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PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project N A / r '0N
Owner's Name /last Fi M1 d
y N
Project Addresa(Street Name&Number)/
/:0-2`—p f /3 i
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'O#1 Subdivisiert/P17(lemb rr
X' 5¢4 - 7,o , >�2� I Plat M 76
Apo.: Address
City St
//' �o Phone --4(�G� Business Phone7 1
QseNr,eto, Address
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I State L Zip . (R1 Phone ,
. ,,
.- l License M Business Phone
/' ILU.4 ..5- S- l 9eie. ��. -Aa 7
ate ,J-,L �,
3e e o .. -�- '' ate- 1-4-'7-'7
Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range pas Log psi Water Htr. Solid Fuel/Wood
ts
0-10,000 CFM 10,000+CFM f• S/oyl
Air Handling Units
Refrigeration,Systems/ 1-100M • 101-500M 501-1,000M
Heat Pumps(STU) •
1,001-1750M Over 1750M
I0-3HP 3-15HP 15-30HP 30-50HP I 50+HP
1-5 Outlets 8+Outlets
Gas Piping
Gas Fired Heating Systam 1-100,00013TO 10u,:A0+BTU
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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 corn
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 'O 6- :/,--_ •-.- --/-(_-i- ,DATE.. /, - /t
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