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1986, 11-17 Permit App: 00014273 Wood Stove
i ,. 7,05441 - 317 MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Project# Owner's Name Last First MI 14ri/ 3e p(--Io /It9h Project Address(Street Name&Number) City / State Subdivision/Plat Name 747 (i 14 r -i)_C- LA A Assessors Ilarcel# Lot Block Plat# Applicant Address 11 a II �i/'e___L,9E -e, L /6 /O 5/0,- 4U(' , City State Zip Phone Business Phone Contractor Address til Ly J-i1 /' e' (> / & (6 Se/Acyk,j City State Zip Phone t)er4CiAi-e- Lc)p %9©.x .7 gD"7ga Contact License# Business Phone ` Describe Work �-`r - ti 0 5 eu nt. i O"bO J dt t 'o v p l-22, • Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove 0-10,000CFM 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 15-30H P 30-50H P 50+HP 1-5 Outlets 6+Outlets Gas Piping Gas Fired Heating System 1-100,000BTU 10%.,,,00+BTU Ljr,v 1 9 1986 .\, =.3ECEIVE ! _. 4 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. '' joikcte . SIGNATURE OF —\1 b—�,�, 'A , APPLICATION OWNER OR �0. .DATE I 1-711 .