1985, 07-18 Permit App: 00006637 ACMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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 coria
=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_
ete,
APPLICATION
DATE
,*0
Project* 0 (0,-221
lC�
First MI
Owner's Name /�/,�/La/st,B� 7(JL)A
*le -)
1
l.f+
- Project Address (Street Name & Number)
. aa- ,
City [State
Subdivision/Plat Name
Assessors Parcel # /
1���'-0cOh2` „'
Lot
��
rAY
Block
�
Y•
Plat #
izlr
Apppli-caanttI �% yy//�
�-71'6�-G `!' /
Address 73.7,1..___
f , die.4.44.2L
1 '� �-- fi
City /
State
G
Zip
'9907-'7--,---
Phone
7-7,,a —x-30 3
Business Phone
Contractorri
(1A/i. _
Add / V' a' 1"� - 3 70 7
r City
State
Zip
Phone
Contac -
971w6441 217E4- S»lde4!L/
Lici se #
�J-1A-4r. --:1102-!
Business Phone
Describe Work
`
4 .:,/ , al/14..i &Aff_ijeje-yfaz,„,t )
Fans
Evaporative Cooler
Hoods Electric Furnace/Ducts
`
Miscellaneous
Dryer `
Range
Gas Log Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1 -100M2
*/00e) 6+4'-
101 -500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30H P
30-50H P
50 + HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10v,,A0+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 coria
=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_
ete,
APPLICATION
DATE
,*0