1985, 11-15 Permit App: 00008725 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORK$HKU
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 O APPLICATION /
DATE
OWNER OR -'�"
Project #
ti.
Owner's Name __Last
First
MI
Project Address (Street Name & Number)
?
City
State
Subdivision/ Plat Name
Assessors Parcel #
Lot
Block
Plat #
Applicant I
Address
City
State
Zip
Phone
Business Phone
Contractor ,
U�C r7,c
Address
Lel Ac
City
State
Zip
�r v
Pho e
7.`Z --?
Contact
License #
Business Phone
A' 2. _ �
Describe Work �/
,0
A
Fans
Evaporative Cooler
Hoods
Electric Furnace/ 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
777
Compressor1
P
3-15H P
15-30H P
30-50H P
50 + H P
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System / _�
1-100, 000STU
10.,.-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 O APPLICATION /
DATE
OWNER OR -'�"