HomeMy WebLinkAboutpitkin.eh.264536210001 (1993) Fireplace Registration,inted an Req 'led
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Name of ow= of proper+
Owner"s MaWng Addrew
Street Address of "ert
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ARCHTTRACTOR DESTGM GRP.
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# OF I)ECORATWE NATURAL GEIS FW
PLACE APPi.YAi* W f 4" Q 5" CLASS
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MAKE, MOIA #
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VOUS THE FWPLACE HAVE AN INSEW
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# OE FIRER-c.:N"'*
# of pECCORAIVE
ITLACE ADPL
+`` CLASS B V1
.. MAV , MODEL # ]I�
ROOMS) AIS/Im
ROOMS)
CATALYST?_—.
NATURAL GAS FIR& I
1�14.i'7
4(T7 M4" ORS
PMPLACES
THE l'A" COWAIN AN
# 01: arRER OLVICES
WOWS)
agg
e being �fgllcd in bedroom, the Swiidtng DepartmentDepartmentxe-
-If gas as [0f;s Gat; a &A9 api�iiase�c arthat the gas lug or app is 1pPr0vcd for Irstallatton in a bedroom by UL ar
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AGA and the M anufac tuxer. pate �- --- ` fte Paid
�. 5ig"[we of Appliant tutenE rar�xl
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PMII- FOR FIREPLACE QST
Paper
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r lame of ow= of pxapert}t
ownees Mailing Adm as�r- C,
Street Address of Propwty 72L,05 Mtn L�rll i7 C'sl�-7 QU;:rlj)_ �TJQ +r iSS$ uJ• 1
Lagtl Desai), "A t��–�\
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Owner -o 1�onc Number Fartel TU# of property--- �� . '
Tax Srhedule ## of Property
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lZoinmerd2d/Office D e'r
chcdL uxl= New Constrns3lim i—[ R+amndel
MBER &TYPES OF I)AVICES YOU PT AN
TO INSTALL:
im OR rriiTCFfM W Wit?; M— VM7�
ROOM %or
CATALYST'S4�
# OF j-wE'PLA.CBS W/ GAS LOGS --
MOWS) _ --
# OF DSCORATlVE NATURAL GAS ME
PLACE APP'MANCES W / 4" OR 5" CLASS
0 VENT
MAH MODEL #
ROOMCS) -
# ()F WOOt) INCIM A.CRS
�O TI -M p 3PLACE HAVE AN INSERT?
(yes /no) ,rV- E_ � r" z ems-
# MHER Dtiv"s TYPE-
--ROOM(S)
MIMMM &'I'(M OF DEVICES YOU AL-
RF-A1)Y HAVr�
a OF f'FIRTII~'rm WCY,)0 TOVM
MAKS, MODUL
ROOM -
CATALYM?
# O% MEMAiC1S IGAS 1GOGS
# QF VECORA M NATi. RAL tiAS
PLACE APLIA2 CYN (W rM V'
CLASS S VENT) _
MAKE, M401M #
ROOMM
# OF WOODBURNING PLAcT-S
ROOMts)
DOES TM FIREPI..AC"E CONTAIN AN
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#t OF C n'HER. DEVICES _ � TYPE —
ROQU(S) - —
ff gas toga or a gets ttppliatiec are being installed ern a bedroom, the Suild[ng D�epaertment ft -
quires proof that the gds log or appliaxmw is approved for inStallaticy>tt in a bed,rvd 2 by UL vr
AGA and tke manufacfuzrer. Date Fee Paid
signature of appli"Ak date...d(`"� '" Etatt�e P id _.. 1__.L/", �'�—
En�tronauntxi Health pepazcment appgaval �a