1985, 09-18 Permit App: 00007851 InsertMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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 rovisions of any state of local laws regulating construction or the performance of
construction. �' 2iGav C ZZ� 2
SIGNATURE OF APPLICATION
OWNER OR L�/I7/,22,-,/./77/"{„V..,7n DATE %'/f-
Protect 0 786, ,
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Owner's Name Last First MI
M Onciy (',v. k) .
Protect Address (Street Name & Number
lV 30Q &&2.a ./_e'
City
Spo ko -n v
State
V' V/' 0
Subdivision/ Plat Name
✓Fif2A LbO is L%S
AssessorsP ft
Lot
Block
Plat 0 , S�c,Q
Applicant
n' n L v0C13 wpvj J J.
Add ess �p�)
��e 3oa � I�! Wei
City
jp() k6 -n t.
State
IN (R
Zip
9 ca16
Business Phone
Contractor
L">!7/?E72 Shield C/2/>n vat Serv/ce—
Address
E.3007 PA-011-C-OUvliCelp
City Sn e..
p 0 is
State IJV A -R
Zip Ca o 7
Phone
311-9-- a o y6)
Contact
.Re4s Lira 6S6oa
Licensee
oR h(E/tlC.S/-5-5Kn
Business Phone
Describe Work ` '^/ ,, -/r, r' n Y SO-,
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Hb.
Solid Fuel/ Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M -
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-1511P
15 -301 -IP
30-50HP
50+HP
Gas Piping
1-5 Outlets
8+ Outlets
Gas Fired Heating System /
1-100,000BTU
10v,:,00 +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 rovisions of any state of local laws regulating construction or the performance of
construction. �' 2iGav C ZZ� 2
SIGNATURE OF APPLICATION
OWNER OR L�/I7/,22,-,/./77/"{„V..,7n DATE %'/f-