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1986, 06-20 Permit App: 00011714 AC
MECHANICAL PERMIT-APFLiCATIONWORKSHEET PLEASE PRINT AND 'C:� .O MPLi� E,:I.•TVixttE,i `ON� L:xMY CITJ�7/7 itV'tS'O T4tfrF��- O.: %R!•,'.`r.ly t, YOUUNDERSTAND r 3 Name t� t Proiocl Address (Street Name & Number) ' F /2 c< ,�©G`�� f/)Z91 4 / iState First MI Project N As-vwsors Parcel N Ad9licanl Subdivision/Plat Narsel / Talair+ L 7 V(LLI Lot Addroes Block 2.. Plat (r --cg.) State' Business Phone rac for o,1A/rs/ji /1.C.4/,e G e‘2 Cc^tac!� r Stele License N AddreR10947- J 7V /p Zip°...... Phone /7// Business Phone ! i x33cribe Work //V../ 74-4 Evaporative Cooler Range Hoods Electric Furnace/Oucte Gas Water Htr. Miscellaneous Solid Fuel/Wood Stove ,,andiinp tinge 0-10,000 GPM 10,000+ CFM Re,lriperallon 5yslema/ .1(-zo Pumps (BTU) 1.100M 101-500M 501-1,000M 1,001.1750M ^n,essor 0-3HP 3-15HP 15-30H P 30-50HP 50 + HP ,:;as Piping 1-5 Outlets 5+ Outlets :;as Fired Heating System 1-100,000BTU 117,, 00+BTU certify that the above Informatlon'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 mate or cancel the provisions of any state of local laws:regulating construction or the performance of ;onstruction. S GNATURE OF / !� APPLICATION OWNER OR /'� DATE E' ///`-‘rr