1986, 01-13 Permit App 00009446 WoodstoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
'17
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 J i ^ APPLICATION
OWNER OR DATE �'�S
Project#
Owner's Name Last First
✓V25, ,btus nn/ -\oJ�2T
MI
G,
Project Address (Street Name S. Number)
City
State
Subdiv' ion/Plat Na _
�Sr �2QEws 3
ss
Aessors Parcel # C75 7
`V G `
Lot —7Block
Plat #
Applicant
Address
City
State State Zip
Phone
Business Phone
Contractor
Address
1= .'�
City
State Zip
C—
Phone
Contact
nnr�r�,-,,l �p;�;,c('-�
License If
^ter-ttiresiSsK�
Business Phone
-jX4--oarG
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Units
0-W,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,OOOM
1,001-1750M
Over 1750M
-HP
Compressor
0-3HP
3-75HP
1S-30HP
30-50HP
SO+
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,OOOBTU
10v,XO+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 J i ^ APPLICATION
OWNER OR DATE �'�S