1987, 08-01 Permit App: 87002477 InsertMECHANICAL PERMIT APPLICATION WORKSHEET
-PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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SRC
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 OR
OWNER OR
APPLICATION
DATE
Project « 2 fill
Owner's Name Last First MI
4
Project Address (Street Name & Number)
I 0a7 601/ J
City
_
State
'
_
SubdlvlslonlPtat Nam
Ara Parcel
Assessors itrL3rJ
f 3 Ivo i
Lot d,
Block
Plat 0
Applicant
1
` Address
111
City
1 State
Zlp
1
Phone
Bwt .s Peone
is.'. car-
MO.!
ZIP.
' Pt orr . r5 .1 ,
Contact V
t hcrw / , . -_-
Business Phone
1 .e"�`" _ -.
—{- .,416
cL c am,a.ccr „)4}'-',.,
oascrtb.Watt PK,fi�'2 ( mom. 0.L- C) r. L"'' (-. l,4t
Cl
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Alr Handling Units
0-10,000 CFM
10,000 + CFM
Refrigeration Systems/
Heat Pumps (811)
1-100M
101-500M
501-1,00DM
1,001-1750M
Over 1750M
Compressor
0 -31 -IP
3-15HP
15-3OHP
30-50H P
50 + HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,0008711
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 OR
OWNER OR
APPLICATION
DATE