1986, 07-17 Permit App: 00012277 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Ac sus
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 /P%
APPLICATION
DATE
Project# /2277
Owner's Name Wt FirstP MI
Project Addre (Street Name & Number
/ (70? P A) ic,,,,Ly"S ,o ,4-N
City
54 A-
State
Ce -
Subd on/Plat Name
PP V4a.E-v Vt s -a
Assessors Parcel # bE5i-01/Q0- O0
Lot / e
Block
Plat tl
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
/- 'q -e) 4 7; /2 d (a_ 4 (0
Address
(N5a5Y Ye e z'Y
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POP) A-/!/ G Sty
State _ `�- -
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Phone 3 L/ -' 7 % 7�
Contact )
.I) h 4C-1/11 P
License #
x mor? , 7OirdiA-170 ✓gz
Business Phone
,-827—¥97,)
Describe Work Gy /
Af
-ea[cz-z t_ /-'/
Fans
Evaporative Cooler
Hoods rlc#naca/Ducts
MiscellaneousDryer
Range
Gas LogWater 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 L-
3-15HP
1530HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU G.-"---'"---
1Qy;,00+BTU
"/ % ' ,1 /r2e7(.,�.0 f -E,-r- ,e, ,CLc:C.C7�l�%C�-=C�,`
c� r o,✓. 'i , 7
/ /
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 /P%
APPLICATION
DATE