1985, 10-07 Permit App: 00007894 PipingMECHANICAL PERMIT APPLICATION WORK=MEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
n6 to /ce
CHH
v
Project # --i //z/—
/ f
Owner's Name y� Last 1 / First MI
7-24%14"- E I <TA1. c 1
Project Address (Street Name & Number)) p
'r?T H (iC3 eco/,/4Nr l7D Qjz
N(.'r? C>
City
State �1
Subdivision/ atr me G CI r - IZ7—
TAssessors
Assessors Parcel #/ 354 • . //C
l
Lot i
Block 3
Plat #
Applicapi, � � �
Address
City
State
Zip
Phone
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
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
0-3HP
3-15HP
15.30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
%
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10.,L00+ 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 OFA
OWNER OR .>/ 'a"'C'W
APPLICATION/(_,
.DATE
/s3