1986, 10-06 Permit App: 00013437 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
jle" it/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
OWNER OR
APPLICATION
DATE
Project # /3 t j3 7
Owner's Name Last First MI
ACC L- p>11.,5 01 k 7 T
Project Address (StreetName & Number)
l el 7.1 Q 6—iii4C6-4-i/2i
City State
Subdl on/ Plat Name
Assessors Parcel#
al 51/2-- 3Q07
Lot
Block
Plat#
iroz5
Applicant �'`�
5,i 6 --
Address
City
State
Zip
Phone
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work
/v'‹,--710-4( tvez.A...) 6.-m -Cc_., fi/2 "leg-- 6.-767z— ��.yw
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr. to .6,0
Solid Fuel/ Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
1
501-1,000M
-
1,001-1750M
Over 1750M '
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outletsmoi,
Q to 4 5 4
6+ Outlets
Gas Fired Heating System •1-100'000BTU
_
104,0;00+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 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
OWNER OR
APPLICATION
DATE