1988, 02-22 Permit App 88000297 Woodstove, ChimneyMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project # 88 "f/�
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Owner's Name Last First MI
Project Address (Street Name & Number)
10g0.7 E. et )-
City
SFD"-,. `r- `.'
State
Get% i,4
Subdf• on/Plat Name
S� Jim V 1 rce) ASS
Assessors Parcel # V _ /CSe
[/( •J
_ 62O _ /
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Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
—1P 6eICC /J(�.� L E
Add ess
, c 3O R,
City „ ^OC
J� (��
State
Zip (eZU�
Phone 37Y
Contact
&
License # �. q
10 1�t1 C 6)276--
Business Phone
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Describe Work -
tfbAe<(,STI 4 (-- L),DCo "-tvL. t PISi2 5.1a-r`te Ciiii3 4-11, Ner4r
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuell Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-3OHP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10,,,, 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.
SIGNATURE OF_ APPLICATION I_,., 1Q
OWNER OR DATE 6 l