1986, 12-11 Permit App: 00014505 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
APPLICATION
DATE
Project # /4605
Owner's Name Last First MI
a_0(r CSD 12
Project Address (Street Name & Number)
Al . a,i 9 e �n /cLin
City
Spo-ten &
State
u
Subdivision/Pe
��ll
Assesso Parcel#5_ /3 `
(/� (G/CIJ�
Lot
Block
Plat # �4
Applicant
A 1, L6 y ,re /2L, e"�
Address
r
2. 7 C0C,/ a �( i, ca ,f
City
Ue,r4dig-ft_
State
IA)A
Zip
999ca'7
Phone ft,/
c -,)2-2-7--P'6
Business Phone
Contractor
U A LLG rift• p�/9e -�
Address
�3- C. (D, 0 Sn
prjde--1
City /
(,).P rp4c /-e_
State
WA
Zip
9v.5-, 7
Phone
9 D-2 - ..a.-7 x6
Contact
(
License #
UP LL& -F CUA
Business Phone
Describe Work Yrs ��'„�X Ct ! CE a 4 t� 1�/t�C�U OS �U C u t4� 0,.4-P/L� Y uttir2
=1(.1.1
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
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
Over 1750M
Compressor
0-3HP
3-15HP
15-30H P
30-50H P
50 + HP
Gas Piping
1-5 Outlets
6 + Outlets
Gas Fired Heating System
1-100,000BTU
10%,,,300 + 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 OF
OWNER OR
APPLICATION
DATE