1985, 10-03 Permit App: 00007846 InsertMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 2 --
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
OWNER 0- I)0- -�
APTE CATION- �S
Project
Project # J
—7e
CJ i
Owner's Name Last First MI
5-011 P.50P) CCirL IR
Project Address (Street Name & Number/-
S. 17'6 3 / --c-o rest m ccv(. _1 2.
City
State
Subdivision/Plat Name --CoreSf 6)1 e�act) /"JL
Assessors Parcel #.35 V:.3 O ole
�
Black /
Plat N
Applicant
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 Unita
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
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
5+ Outlets
Gas Fired Heating System
1-100,000BTU
10u+,,-,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
OWNER 0- I)0- -�
APTE CATION- �S