1985, 06-13 Permit App: 00006041 ACMECHANICAL 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 provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF �- b,` _� ) 2 APPLICATION
OWNER OR ei5�� ( i %✓l.�k'l-�_ DATE
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Project # 6(y'/
Owner's Name Last First MI
ilk' • — `i (Y-4, b-(/'- t
Project Address (Street Name & Number) t 71 •
City
State
Subdivision/ Plat Name
,L -1-t/ 5u6
Assessors Parcel #
Lot /
Block
Plat #
Applicant /j' %
y� ^
Address
City% 213j4Q ,_State
)
Zip
Phone
Business Phone
Contractor 4 ,
/l`
Address 1
City n
/fi
�) State
tj
Zip
Phone
Contact ///
,,LZ..f�i.-• L"rA i
License #
,..(-1.- -Lur' -31, - : JA)
Business Phone
-
Describe Work ,
/ 6/1;(32--e.' 2
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM _
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
I
FI ///
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-3OHP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10.,,:.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 �- b,` _� ) 2 APPLICATION
OWNER OR ei5�� ( i %✓l.�k'l-�_ DATE
/f