HomeMy WebLinkAbout1987, 08-17 Permit App: 87002715 Boiler IP' a
k MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project# *E?:7 .--1/
Owner's Name Last First s t MI
i'q i.rO N C n �)///f 600/=Yj H
Project Address(Street Name&Number)
/V 702 4541/&/(15 ,eo,tll)
City State Subdiviisiq`'/Plat Name
bpd 14 t, , 1.O IC -311 V E2A1.
Assessors Parcel# iliSi 6�.�C 8 I-4
"1 "4 Block Plat#
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Applicant Address
e/Z/h-(/fS74 /. .- _ 3J-/5--- 7- -X.if
City State Zip n Phone
��v/Z/0A.0 Z-4,/x)s 7 -1d G'Z_ �'3S- i3bo
Business Phone
Contractor -,/, Address
JJ ,�'/4 95 f '3
coi < , ,/5 7-72e- j---
City
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City State Zip Phone
t&o /ZI, i.....-C__ A/la -5 LI 5 ' a--4 `. 6-55-i3C-) U
Contact , License# Business Phone
' rt-NSt.. IS(LS _ 7-7'
Describe Work
"C--791OUE 6/ / L) Oc/Lo, o- /.v5'T.oze' Gx 5. f"/. � A r ' c.)G G((-C(
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
r 0-10,000CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping ,c2 -4-,, / /,,,;,
1-100,000BTU 10%,,,;00+BTU ,la, 50-6Gas Fired Heating System
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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/ /U APPLICATION ,
OWNER OR ( ., t�, z- DATE ?"---F2