1985, 06-05 Permit App: 00005937 ACMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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RAlei
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 4),e4///
/ APPLICATION�� � AATE
OWNER OR +� �/� v.S//
Pao sqs_97
Owner's Name Last // First MI
'74X I-1ZI.'•i -2ad-- /.J •
Project Address (Street Name & Number) %/����� V
a ,,n1 m .r rt..d • S T C102• 7
77 • la. {3' b,..l
City
.-%%in ij/U>Le-
State
%te..,i
Subdlvislon/Plat Name
6 k'pe fti /*sb/�e /-/OHC. is/
Assessors Parcel 00552 6/,05
!— (�
Lot 5
Block `
(�Y(
Plat It
Appl lrantA
/--CC�-lv�t,(.- /0 n_a-nyt)
Address
n
-r- • 1/:-.�- / /y, /t.,r.�m_/rrrk,
City V
�fpo f' a—nx..-
State '
4.I.
Zip
996'7'
Phone
;z6 - £/ 1I
Business Phone
Contractor
�n )MAC- t
Add ess
�C • r ; . .-3969
City
StateI /)
vv
Zip
�zw
Phone `z1
1731 i7a =-
24
Contact / —
"/"."141:1--C-)
License II
_'i -, r - ,-, 5 .2AA7--
Business Phone
Describe Work
7(.511--e2 7207) i1,an,r_476e' _
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
AV Handling Unite
0-10,000CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100MQ
SS. 4 rJ/ (r-•
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-5OHP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,0008TU
10,:,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 4),e4///
/ APPLICATION�� � AATE
OWNER OR +� �/� v.S//