1985, 10-03 Permit App: 00008017 Mechanical FixturesMECHANICAL 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 %c9/3,37 r
Project 0 P i 7
C
Owner's Name t / �Irst MI
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Project Address (Street Name & Number) //
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State
Subdivision/Plat Name
Assess rs Parcel 0 -7 CL, 0)
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Lot
Bleck
Plat N
Appli%.9
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Add ess �,-�
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ity u
State
Zip
Phone
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
LIcewe 0�/
, .PUS / /l/ CT2J
Business Phone
Fans -
Evaporative Cooler
Hoods
Electric Furnas ucts
Miscellaneous !/ � _
Dryer
Range
Gas Log
Gas Water Htr. `
Solid Fuel/Wood
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
03HP
3-15HP
15-30HP
—
30-50HP
50+HP
Gas Piping V
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1400,000BTU
1q,,:,00+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 %c9/3,37 r