1986, 06-06 Permit App: 00011727 Heat Pumpac
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project rt 1/727
Owner's Name Last
"L(F/rst A , MI
Project Address (Street Name 8 Number
City
Statej4 q �/�
Subd� jelb)Plat Na`S-
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Lot
Block /
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Applicant I Address
City
State
Zip
Phone
Business Phone
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y
Address
/7 D V<rremacir_�
CI
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StateJ
9TH /7.
Phone
7c- Sao
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Licensee ,
AM CZ u h H E - 113A11
Business Phone f
1-Glomi-e_�-
Describe Work I
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&- - l.�C�-G\ ��'�
Fans
Evaporative Cooler
Hoods
Electric Fur ace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Wate Htr
Solid Fuel/Wood Stove
Air Handling Units
0.10,000 CFM
10.000+ CFM
Refrigeration Systems!
Pumps (BTU) `7.Ui y Oct
1-100M
101-500M
501-1,000MHeat
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10,,,: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.
OWNER
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6'(� ✓ 11
�e� ��'� DATECATION /_ 6 _3-,4