1985, 08-21 Permit App: 00006995 Mechanical Fixtures"7j
S
MECHANICAL PERMIT APPLICATION WORKSHEET �.
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Z.
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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
APPLICATION
OWNER OR DATE
Project* &/%
Owner's Name Last First MI
F1uEit41 /-A/2i21
Protect Address (Street Name &Number)
5 70 Z- `s62,1e-77-4
City -
State
Subdivision/Plat Name
Assessors Parcel# C /5 )
Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
-
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License*
Business Phone
Describe Work
Fans
Evaporative Cooler
1
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr. (e,
4o 64L
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
1 30-50HP
50+HP
Gas Piping ye S
1-5 Outlets L "
6+ Outlets
Gas Fired Heating System
GYe_s
1-100,000BTU
10v,v00+BTU
,r ,
/ — /00 ,0 00 /3 711 G•.ers ,4-4.41-444•C e
1 - VO & - Ai• W, 7: iiiet
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
APPLICATION
OWNER OR DATE