1986, 05-29 Permit App: 00011276 Spa HeaterMECHANICAL 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 alt 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
PPLICATION
DATE 5 Z 7
Project 0 / i 2:16
Owner's NameLast First MI
Di4v kS Lam.
Project Address (Street Name & Number)
k'S L2 01,".._r___C.c
1 l
CJS
State t
Subdivision/ Plat Name
Assessors Parcel 0
Lot
Block
Plat 0
Applicant
Address
1 3 t a rJ
`t12l —
ity
St to
��..�� �_
Zipp
t cL1-AD 1
_
Phone —• 1--6 --SID C,)k
Business Phone
Contractor
Address
City
State
Zip
Phone
ntect
License 0
—t— 4--t 44-0 t't I- i 'tel '1 `— o
Business Phone
_3 *Lc -e,'0
Describe worka.,....k.s.......
£t'Fans
Evaporative
H
Electr c nevi 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)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
-.
Compressor
0 -31 -IP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-50utleta^ _
(C�
6+ outlets
Gas Fired Heating System -.
1-100'000BTU
106,;00+BTU
I/2 ( sem
(________
.,? ..
I certify that the above information as submitted by me is true and correct and further, agree that alt 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
PPLICATION
DATE 5 Z 7