1986, 06-06 Permit App: 00011825 ACMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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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
OWNER OR
J/ 1 tii,Z APPLICATION
C DATE
Project it 1182,5
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Owner's Name 1
L - ' , n Fir �1 MI
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Project Address (Street Name & Number
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City
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State
04
Subdivislppl-�Plat Name
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Assessor arcel#
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Lot
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Black
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Plat it
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor b l 0I, ^ t _.) , / !: 1
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Statecc /,
�lLLlicensee
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Phone L9 ti /D �_
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Describe Worker/ L 9 / gg ,—y -`"^ w 2c eghi" .e1.24...7-4___
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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/
)QHeat Pumps (BTU) V 500
!T f
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10u,;.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 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
J/ 1 tii,Z APPLICATION
C DATE