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c� �$� <br />� APPLICATION FOR MECHANIf,AL PERN'IT <br />(To be filled in completely by applicant) <br />�✓ DATE O - Z 7 - � / _ � <br />�NAME (Owner) NiA�AR/i �F uiRS�!_T /.4/C.`_ PHONE NUMe�R _ 7y,3-�/3 � �_.._ <br />�ADDRESS �v62� ,�UL�tcy__ tScvO. ---- �ITY c�'o'nE77- ----�IP COf1E._982C�3 . <br />�CONTRACTOR �C��Rc2�tl __'��lzi� _r_uC_ PHOIVE NUMBER. 7G3 ~_!_�Y y___ __ _ <br />�DDRESS �27 So • KE)uYuti ____C.TY �E79TL-tC ___Z1P CODE^��/Q� <br />�NTRACTOR'S LICENSE NUMEER V-t-�2_G�'1��1_(�7__ _ ____�_____ <br />y�DDRESS OF JOB 6�Z`'i �ZC�z�_ hlV�?�_.._—CITY_����2�___Z(P CO�E�B'BD�___ <br />/ waR*+�Rr+**k#+�ki.**i*i.#r*il.ii.lr aRA+Ri.**r#feM+* k* #w #* d++A rx# #Ir kir M+f��**Irirf+� /rir*1r *it�. k wfir+lr***fr**f,tr4 ir <br />�USE OF BUILDiNG =�fbw �io� __ _ _. Plew <br />�i9ESCRIBE WORK Nt�c� F�Kti�-1___��'� �u"'!� Oil <br />_ 1lddition �Alteration _ Repair <br />_ Nat. Gas _` LPG �( Elec*ric <br />a *�'�' �,"k'k'k'4"k'k # ** �"%'k'k * � a'k *'R �k'R'k Y'�"�' a **�'k'i"k *'�'k'k * *'�('k'k *'k lt'�'n * t a �' * * * �` 1� * * r �'i'k'w � *t* �'* *'R i i * i i* * 14 *'k �'�' f'k'I"# /( �'tr � <br />t <br />+ <br />Square ft;, in Building _._____ * PF.RMIT FFFS <br />*_- ------_------•--_. -------------- <br />* <br />NOTE: fuel piping is not included in this ;'10. TYPE OF EQUIPt',F.NT � F�"' <br />permit. *___ <br />*.�*++*�,.,...***++«.+*.�*....+��+.*.*.++...�.* ------------ -------_ - - ---- --- _. <br />* Forced Air Systems <br />�i1pp!ication accepted by ; btu i:w <br />� --- - i . - ------ - -- ----- <br />auilding Permit F <br />�ax .Account q_ <br />•�....*+•r«.+*ra*r.*++�*r•�...*.++.+«*....++: <br />I HERE�Y CERT?FY THAT I HAVF READ AN� EX- <br />AM(N�D TH;:i APPLICATION ANO KNOW TNE SAf4E <br />TU BE TRUf. ,�Y� CORRECT. ALL PROVISION GF <br />LAW AtJp ORDINANCES COVERItIG THIS TYPE OP <br />IJORK WILL DE COMPLIED WITH WHETHER SPECIF- <br />IED IIF.REIN OR NOT. TIiE GRANTING OF A PER- <br />h11T DOES NOT PRESUPIE TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />O1'HER STATE OF LOCAL REGULATING CONST- <br />RUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />�Oif���_����Y� ' <br />Signa�ure o� Co tracto or Author�zed A nt <br />y gnature of wner if owner-bui�der) <br />F�al Storage Tanl:s <br />Size in gallons --------, <br />Neat Pur�p <br />Free Standing firepla�e <br />'Aond Stove <br />Fire Piace Insert <br />. <br />k <br />: '1isc. <br />. <br />. <br />. <br />. <br />. <br />. <br />Ver�r�i t: h <br />Permit Fee <br />Total Fe <br />C:i)i' 4-Hl/5 <br />