1985, 10-18 Permit App: 00008157 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORKSMtIET
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-ef any state of local laws regulating construction or the performance of
construction. _ J
SIGNATURE OF f APPLICATIOJV -C�
OWNER OR 'L,Z Z %' .DATE / 1 l %
Project #
Owng ,s Nam
t First
MI
Project Address (Street Name & Number)
__-..
oil
,
City
State
Subdivision/ Plat Name
Assessors Parcel#
Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor r
Uva° f
Address
City
State
Zip
Phone
Contact
License #
1<Q
Business Phone
Describe Work
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
T777-
Compressor
3-15HP
15 30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU -h_ .- '
10v,�00+BTU
c.
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-ef any state of local laws regulating construction or the performance of
construction. _ J
SIGNATURE OF f APPLICATIOJV -C�
OWNER OR 'L,Z Z %' .DATE / 1 l %