1988, 01-19 Permit App: 88000168 Prefab Chimneyr MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
4000As
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 corn -
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
b &A.
APPLICATION j7 _K
DAT `
Project it EIS ---- /f_LI
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Owner's Name Last/5r� �y
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Project Address (Street Name 8 Number
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City �� , C4eS
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C - State
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S rv'sion/Plat Name
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Assessors Parcel #
l - 27x50
LotBlock
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2Appl1855
Plat #
icant
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor _
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Address
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City I
State (,A
Zip il^ � Z
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Phone 5�
Contact �.
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License ti
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Business Phone
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Describe Work
0 )esnikti— Pte' Clit+ 0, ii -'t TI, 46-PcbtCC: 32QcC e-Gf-c....; aEsY
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Alr Handling Unita
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
3-15HP
15-3OHP
30-50HP
50+ HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10.0;004 -BTU
(D t) 0_ AI -401 TOM
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 corn -
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
b &A.
APPLICATION j7 _K
DAT `