1987, 05-29 Permit App: 87001719 ACMECHANICAL PERMIT A-PPUcATfON WORKSHEET
SE�(PARTS OF THE CORM YOU, UNDERSTAND
PLEASE PRINT ANO COMPLETE ONLY. I , , w ..
I certify that the above Information assubmitted by''me Is4r6e 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 0F APPLICATION
OWNER OR ,DATE � ✓'�� l
SVA I
Pro(ect M i
Owner's Name
FI It
Project Address (Street Name 6 Number)
city Stale
A
Su vlsl IPlat Name
Lot.
Block.. Plat M
Asressors Parcel M /
n
Applicant
Address
fState
Phone
Staling Phone
s
Contractor
Addrau
Cily State Zip:,
Phone
Business Phone
Oascrlbe Work �� /�
C �'/� /r✓'y/aT-� _ /�
Fane Evaporative Cooler
Hoods Electric Furnace/Ducts Miscellaneous
`
Range
Das Lop`',' Gas Water Htr. Solid Fuel/Wood Stove
Dryer .
0-10,000 CFM
10,000+ CFM
Air Handling Units
r Refrigeration Systema/ 1-100M
101 _500M
501-1,000M
tieat Pumps (BTU)
1,001.1750M
over 1750M
0 3HP
3 15HP
15JOHP
30-50HP
50+HP
COtr:pr86apl
s� j� �
,✓
1-soulieta
6+ Outlets
1-1o0,000BTU
10.,; 00 +BTU
Gas Fired Heating System
I certify that the above Information assubmitted by''me Is4r6e 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 0F APPLICATION
OWNER OR ,DATE � ✓'�� l