1986, 09-12 Permit App: 00013099 InsertMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
43
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Project
019
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Owner's Name }� , Last First 1 �1 MI
LN 7CVV\t kA I.--( LIQ
Project Address (Street Name & Number)
City
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State
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Suby' on/Plat Name
( )RC(] A 2D !-'�d t? k -
Assessors Parcel q/ 253 3 _ 6 / o-63
Lot /
Block 2
Plat q
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
Licensee
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
I/JSERi
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
10e,..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 APPLICATION /
OWNER OR \GWS DATE �� (�� /2` 6.