1986, 05-01 Permit App: 00010901 InsertMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
SSR 1 isx /ea.
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 provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION
DATE`—'
Project I to 496 /
Owner's Name Lagt FIs
C l i lOccl
MI
MI
er
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Project Address (Street Name & Number)
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City'
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State ice,
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Subdlvlsion/PIlatt Name p
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Assessor's Parcel 0 ,35,./.5
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Lpt 5
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Applicant
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Address
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I State
I Zip
PhOf ar, - f
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BuenAss Phone
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contact.
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Farts
Evaporative Cooler
Hoods
ElectricFurnaoe/Ducts
Miscellaneous
Dryer
RIMS
Gall Log
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM
10,000 + CFM
Refrigeration Systems/
Heat Pumpe (BTU)
1-100M
101-500M
501-1, M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30 SOHP
50 + HP
Gas Piping
1-S Outlets
6+ Outlets
Gas Fired Heating System
1-100,0008TU
1 a,,;,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 provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION
DATE`—'