HomeMy WebLinkAboutpitkin.eh.273504401001 (1994) Fireplace RegistrationL., w r 1 1 r\iiv 1=1'4VIrtUI'4ivlcl'41/-kLtILALitI
rintedon�R,;c cled PERMIT FOR FIREPLACE OR STO"F
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Name of owner of property /< o t C_ /1010 ✓r► a A
Owner's Mailing Address V/ e r /P e/ . 03e ,c Fk dr q C.. S-/Gij-
Street Address of Property 0/),o CU Ik f/- 14 t
Legal Description of Property La t /, E'4r-)
Owner's Phone Number 2) ,3 - C 2- 0 v Parcel ID# of Property oo /
Tax Schedule # of Property / 3 DQ V
Structure type: Single Family Duplex = Condo = Apt=
Commercial/Office 0 0 Other
Check one: New Construction Remodel
NUMBER & TYPES OF DEVICES YOU PLAN
TO INSTALL:
# OF CERTIFIED WOODSTOVES_
MAKE, MODEL #
ROOM
CATALYST?
# OF FIREPLACES W/ GAS LOGS tiF
ROOM(S) 12rcrr-ft,i R--,&
# OF DECORATIVE NATURAL GAS FIRE
PLACE APPLIANCES W / 4" OR 5" CLASS
B VENT
MAKE, MODEL #
ROOMS)
# OF WOODBURNI NG FIREPLACES 0 b -/f
ROOM v i r
DOES THE FIREPLACE HAVE AN INSERT?
(yes /no) TYPE
# OTHER DEVICES
ROOM(S)
TYPE
NUMBER & TYPES OF DEVICES YOU AL-
READY HAVE
# OF CERTIFIED WOODSTOVES
MAKE, MODEL #
ROOM
CATALYST?
# OF FIREPLACES W/GAS LOGS
ROOMS)
# OF DECORATIVE NATURAL GAS FIRE-
PLACE APPLIANCES (WITH 4" OR 5"
CLASS B VENT)
MAKE, MODEL #
ROOMS)
# OF WOODBURNING FIREPLACES
ROOM(S)
DOES THE FIREPLACE CONTAIN AN
INSERT? TYPE
# OF OTHER DEVICES
ROOMS)
TYPE
If gas logs or a gas appliance are being installed in a bedroom, the Building Department re-
quires proof that the gas log liance is approved for installation in a bedroom by UL or
AGA and the manufact r. v
Signature of applicant Date2-L-1L _� Fee Paid
Environmental Health arimen a val * Date Date Paid