1985, 07-17 Permit App: 00006625 ACMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE QNLV 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 corn-
plied
omplied 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 7,/,
DATE
Project 1 4.-,-,2_5-
f' -,!---
Owner's Name Last F t - MI
Owner's
Project Address (Street Name & Num er)
City
State
Subdivi /Plat Name
gfcYT
s Aoo
Assessors Parcel #
/56 4 "T
itigeoiApplicant
Lot /
Block /
Plat 1
•
Address
72. 5 Ma}»') -)
City /
St to
Zip
Phone
Business Phone
Contractor
'c6.-a--itA/C1-• — al-r.l.- .
Address
City J
State Zip
id-��22//
e
F
�Vy/7/)
t
,, /� Q'
� L ,, —_,(30..b
License 0 `/2 -7 Ali—
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel /Wood Stove
Air Handling Units
0-10,000 CFM
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
1530HP
30-50HP
50+ HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10v,�00+BTU
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 corn-
plied
omplied 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 7,/,
DATE