1986, 10-20 Permit App: 00013926 DryerMECHANICAL 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 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
+1�* (' DATE-
. e -Fd
Project p / j 3c1 2moo
1 /
Owner's NameC/!12DJG.t� MI
First
///�/� ast �� /J
Protect ddress (Street Name & Number)
. >2 ta- a ti
City
A..,k-A---
State
Z•Cil [ s
Subdivision/ Plat Name
'-11 LLLr T pic 2-'(.10 POD
A sors-2-1 J l II 4 41 -- 14 1 1
Lot I I
Block
Plat ft
Applicant
1-1it,...,..)
Add ss
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C
Ity
State
Zip
hone38
Business Phone
Contractor
!l It 1)
Address
City
State
Zip
Phone
Co
('�a„<.L
License It
Nord+is. 2 IOC, L5zz:o'-
Business Phone
DescribeWork t2 }rte
C%_%r ' w"
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer A l
Range
Gas Log
Gas Water H!r
Solid Fuel/Wood Stove
Air Handling Unita
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
0-3HP
3-15HP
'
15-30HP
r-IVL:,
P
50+HP
Gas Piping f/ //
1? a
1-S Outlets
ill;)` ,'( 198E
6 fiefs
Gas Fired Heating System
1-100,OWBTU 111 _
I V
+BTU
ii—c
. Sd
2 g no /? T. G/. -. 0-0
`i 2O 7J t. `-. +.rte . /•f/o
hi ay_sz)
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
+1�* (' DATE-
. e -Fd