1987, 05-08 Permit App: 87001421 AC • ti
MECHANICAL PERMIT--APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLYh z�i Sf:.TARTS OF T�HytEr,eORM YOU;UNDERSTAND
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1
I Project
0 Pis/
Owner's Name LastFI t MI
Project Address(Street Name&Number)
i Y2–‘2i /
C.ty �P� �/. me
Stats //go, Subdivision/Plat l f Na Pskrrnixt413 Out(v-- t. Q
I 't° 16(
Assessors Parcel a 2:7---5i n .n ", I'2'
1BIodc Plat
Applicant (� 1 GAddre s
Clly State l'I Zip •.. •i Phone 5;49
'.r e•.•:t' ' , Business Phone
Contractor Address
City Stats /714-tavO9 Phone ,..6.-3..5-:--/7//
Contact License 0Business Phone
Jol-M/ h;iy-nyi-Alay .48,1/17/1/..ei / 3714/7--- a
Describe Work i.7)4 ,�/V �./is/ _wr/�7a'"/'
Fans /J♦ 3 Evaporstive Cooler Ia/ Hoods Electric Furnace/boas Miscellaneous
r Dryer Range ' Garr Log • Gas Water Htr. Solid Fuel/Wood Stove
0-10,000 CFM 10,000+CFM
Air Handling Units
r Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(ETU)
( 1,001.1750M . Over 1750M
0-3HP . fir I- '' 3-15HP 15-3OHP 30-501-IP 50+HP
Compressor 4/4J
� ^ ` ,
if4
�!. t t-5Outlote tl+Outlets
Gas Piping • -
1-100,0008TU 10.0:00+BTU
Gas Fired Heating System
...• . .
I certify that the above Information as.submitted by'me ls-•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.
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SIGNATURE OF -���/ , APPLICATION ✓"*����
OWNER OR _—.DATE