1986, 11-12 Permit App: 00014190 InsertMECHANICAL 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
�OWNER OR
x Obi\
APPLICATION
DATE %�
Project /I
Owner's Name Last First MI
i /7'ci-F 2_7 Aly (...,u
Project Address (Street Name & Number
EC /f//0#0/ &00 /+)C=
City
State t� ,,11
Subdivision/Plat Name
Assessors Parcel M_
/'/,lig.-3tic y- V
Lot
'3/4/
Block
Plat It
Applicant
G A�y ti), if ,,-0q����
Add ess
L-J//�V 00_,di✓
City
StateZI
Phone
Business Phone
Contractor ^1/
Address
City
State
Zip
Phone
Contact
License a
Business Phone
Describe Work
/i„(5-. s_ UJoA- Se510,e,J/.1* ,re/2G J6gt74-7— i 613--rii.-'T
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Wate Htr,
Solid Fupl/ Wood Stove
/L
Air Handling Units
0-10,000CFM
10,000+CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
03HP
3-15HP
15-30HP
30-50HP
50+ HP
Gas Piping
1-5 Outlets
5+ Outlets
Gas Fired Heating System
l-100,000BTU
10.,.:00+ BTU
'
El VE
DEL:
r4ov 141985
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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
�OWNER OR
x Obi\
APPLICATION
DATE %�