1986, 03-24 Permit App: 00010179 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORKSHEET
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 OF
OWNER OR
DATE
APPLICATION 3 /
Project# /Of 7
Owner's Name / Last First MI
Project Address (Street Name &Number)
S -3,4o..
�_�
Cit
r
State' , \
W
Subdivision/Plat Name
Assess° s Parcel#
Lot
Block
Plat #
Applicant
l/; CA,%".A.16-4)•
%Address
ity
Stat
1.-) ---
Zip
41Lri LZ (
Phone �"
3 2,1 -��Z-e-o
Business Phone
Contractor
Address
City
State
Zip
Phone
•
tact
.vvLtm.`.�<,
License #
—r -n. -L' 4 +e* T. SZ Co
Business Phone
3-1.-c.. —%'1.-0-.
Descr e Work /---
Ibi qd-42-1�
Fans
Evaporative ler
is
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water__Hic. ,
CO
Solid Fuel/Wood Stove
Air Handling Units
0-10,000CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping t3 e
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
CI, rrla
10,;.00+BTU
L J Q—+
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 OF
OWNER OR
DATE
APPLICATION 3 /