1986, 06-18 Permit App: 00011644 ACMECHANICAL PERMITAPP � CI•
CATION WORKSHEET
PLEASE PRINT: AND'COMPLETE'ONLtai'r Y {`tYtl:tbSitPARTS OE„ THE;FORMYOUUNDERSTAND
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Project e f ikez rt
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Owner's Name Leat Fint. ^ "` MI
Project Address (Street Name 8'Number)2"--;•
/678 // A7f/61e.,7;y2r ' `:',,: ` �`•,:
City ' e
Vs 61 ed/
State ///,,,�����/
Bubdjvl(Ion/PIeI Nose-, -R
Assooaasore Parcel 0 t154,2,-1516,
15 , 516
Lot . ,5
Block •
Plat e
Applicant yyff
Address .
Cliv
State
Zlp.'. a��i'a
Phone / `( Sri /
- -
Business Plane
Contractor 4_,Al�� `—e� ... .. - .. -.
Add em iig iT I
nee
City a/% /:.(� /
State
Ii/it
Zip�%� r• 1- :-
-3----v7
PhhOOfl//
,y
Cont VI//�T/4��
C#A//
/ 74< L'l,/ 4' A/1—
`B/0/74<64c,7(
�r6/
-Business Phone
8
Doscrloe Work
/4/.17--.#iC #,(/.0/4./t7/17/0,
Fans
Evaporative Gooier '•
Hoods t
Electric Furnace/Ducta
Miscellaneous
Di yer
Flange. •
Gee Lop ':';
Gm Water Htr.
Solid Fuel/Wood Stove
Air Handling Unita
0-10.000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
' �./
e..�jy /i�js , /
t/6/- tib s� ... ..
101-500M -
,•: .. .
501.1,000M
1,001-1750M'
Cver1750M
CompressorI
-
0-3HP 4.-------"'
_
,3-15HP
... ..''
15401-1P' - - -
•
.
30-50HP
50+HP
' ... L .
Gas Piping
-;.
-e Cut!:ts '-'.r: r-+;".
., ..
e+ Ou0et.
Gas Fired Heating System
1-100.000BTU `- .. - -
18.,:,OO+BTU
911 //00Pir
I certify that the above informatlen as submitted by meas -true and correct and further, agree that all pro-
visions of laws and ordinances governing thls,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 OF
OWNER OR
APPLICATION
DATE
fo-