1987, 01-14 Permit App: 88000093 ACMECHANICAL PERMIT APPLICA-TIOk WORKSHEET
PLEASE PRINT AND COMPLETE ONLY., H(SE<F RTSOTxTH? FORM' YOU., UNDERSTAND
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I certify that the above Information as submitted by me Istrueand correct and further, agree that all pro-
visions of laws and ordinances governing thls type of work, Including inspection requirements, will be corn -
pled 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
-onstr uctlon.
SIGNATURE OF
OWNER OR
APPLICATION
DATE
/—iv- e7
Owem'a Name Lee FIAt �t� /)
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roles Address 191dl Nene B Num,,,{
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State
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Russ Lunt DF_
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Ruins Phone ,�
work
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Evinentive Cooler
Hoods
Eleclrlc Femme/Ducts
MIellarnua
p,,e,
Range
Gat Log
Gas Water He
Scud Feel/Wood Stove
,1, Hand ring units
0-10 000 CFM
10,000+ CFM
pnvipennon Systems/ tems/
.ml Pumps (BTU)
l-1 M
1D1-5 M
501-1.000M
1d:01 -1750M -
Ove( 1750M
h, .-noreesor
I �Hv//2
rot.'"
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115HP I15J]HP
J150HP 1505 HP
„a: PIYng
-
1-5 Outlets
6+ Outlets
EO. :o Fired Healing System
1-100,0008TV
i&, o0SBTU
r
I certify that the above Information as submitted by me Istrueand correct and further, agree that all pro-
visions of laws and ordinances governing thls type of work, Including inspection requirements, will be corn -
pled 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
-onstr uctlon.
SIGNATURE OF
OWNER OR
APPLICATION
DATE
/—iv- e7