1985, 08-29 Permit App: 0007189 ACMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 certify that the above information as submitted by me is true and correct and further, agree that all pro-
visjons of laws and ordinances governing this type of work, including inspection requirements, will be corn-
- pied 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 r/4-%/75'
Project # 7/ 7
Owner's Name j Last First MI
&Ate/
A Project Address (SSttreeetNNaamee & Nd,ber)
11b77 . h /
City
,11t�4a/,C
StateSubdivision/Plat
/iL)&4 , ,, /v
Name 10 K' 1 5$
w (sOP t— „v,.rn) 9 fa e, s wg
Parcel y
2 1'24 - t t16
Lot
Block
Plato
Applicant
Addres b 37o7
City
State
'
Zip
Phone
Business Phoneik, �, .'/
- //7e .�K-T/
Contractor
Address
P- n. a _57e 7
City State 1
Ak-
Z
�9a�
Phone
Aee9-�r7a ..cvt, &�
Con : 1
ae� .0 - ��cJS a
/y
Lioen *
0`z?3 'Di - ••e=/Ii2,—.»i2- 7a kr
Business Phone
Aln16 az abeam,
Describe Work
Fans
Evaporative Cooler
Hoods
Eiectri urnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100MQ /
/0. 7 ��N
101-500M
501-1,030M
1,001-1750M
5
Over 1750M
Compressor
0-3HP 'r n
3-15HP
15-30HP
30-50HP
50+ HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10u,,,00+BTU
1 certify that the above information as submitted by me is true and correct and further, agree that all pro-
visjons of laws and ordinances governing this type of work, including inspection requirements, will be corn-
- pied 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 r/4-%/75'