1988, 02-24 Permit App 88000315 Pellet StoveMECHANICAL PERM'T APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 1 I x!Q!/-b
Project X
Owner's Name
y^��^;'cc) Las(tt��,� I
�Irst
MI
Project Address (Street Name & Number)
City
State
Subdivision/Plat Nam
Assess rs Parcels
OS� J _ d l�
Lot t
Block b
Plat#
Applicant
r�. 1
Address
City,,,
State
Zip
Phone
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License R
Business Phone
Describe Work
<
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Units
0-10,000 CFM
70,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500N
501-1,000M
1,001-1750M
Over 17SOM
Compressor
031HP
3-15HP
15-30HP
30-SOHP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
1W,; W+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
OWNER OR DATE