1986, 05-13 Permit App: 00011073 Gas PipingMECHANICAL 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 tfie provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATIONy (3 _ 2-6
DATE v
Projects , OQ / q
Owner's Name t MI
tajilLete
Project Address (Street Name Ger
E- /4ara- 4n-vLc.
CityStateMIA
Subdivision/ Plat Name
Assess ParcelII
Lot
Block
Plat
Applicant
Address
City
State
Zip
Phone
Business Phone
Cont l ;11 �iu /41r t/ 614-74-774/6- 1»u�
Address 2 7/C .Z7v V /AN4
Ciitttfr.. //,
n/4,4A)
State ����((
(W +
Zip
l 9 /6
Phone
7a1 -(Do
Cont t p License p
�C 711n4-11/4MQuAN-E - 1y 3N / /
Benin s Phone
—
Describe Work - ate ( % et l� /._/ dire Xi7-040
(.,a
I//f_
_Ducts-040M
Fans
Evaporraaii Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
1Gaas-Watater Htr. p,.�
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
' Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over1750M -
Compressor
0 -31 -IP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping gI / t
1-5 Outlets
6+ Outlets
Gas Fired Heating tem
1-100,OOOBTU
1 r -.- U ,42...,,o
•
2,Gr/ /73700r)
/ utze LJ
vI
r
/
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 tfie provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATIONy (3 _ 2-6
DATE v