1988, 09-28 Permit App: 88003123 AC MECHANICAL PERMITAPPLICATION WORKSHEET
PLEASE PRINT AND:ppmY;ZS i RTS�OF , TINq,rORM YOU UNDERSTAND
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IProject It 9 1
TOwner's Name Wt First, MI
ale
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Project Address(Street Name&Number) •.."' ,.
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I pityStats Subdivision/Plat Name
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A89esSOrS Parcel N r...j- Lot Block.. Plat 0
ApplicantAddress
CIty State '1;aD Phone
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Business Phone
Contractor ,,77 Address
',ty State Zip���� Phone
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Contact n
ess Phone
RU SS L(4 Al Df2,1`/V/1/.e-/ -/ ".37,/1/7----
1/License 0
Describe Work
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Evaporative Cooter Hoods Electric Furnace/Ducts Miscellaneous
Fan9
I. Range Gas Log`';' Gas Water Htr. Solid Fuel/Wood Stove
Dryer
0-10,100 CFM 10,100+CFM
Air Handling Units
Refrigeration Systems/ 1-100M
`.101-500M 501-1,000M
-teat Pumps(BTU) ,
1,001-1750M r Over 1750M
l 0-3HP
.2 3-15HP 15-30HP 30-50HP 50+HP
Compressor / 0
` 1-SOuttets 6+Outlets
Gas Piping •
1-100,000BTU • 110v,.;00+
BTU
Gas Fired Heating System
I
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I certify that the above information as'• submitte•d submitted' Istrue 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 OFAATECATION / _ 2 g - Y y
OWNER OR —,e4--i 9-11C .