1987, 05-12 Permit App: 87001419 ACMErE &WICAL PERMIT'APPLICA'TION'WORKSHEET
PLEASE; PRINT AND:COMPLETE'ONLY:, F-{ SE;P,ARTS:OF:;jHE,Form you UNDERSTAND
Akeo
rth
I certify that the above Infor'matron' as'subinitted•by`me.is.t[ue'and correct and fuer,agree that all pro-
visions of laws and ordinances governing thls.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
APPLICATION L
DATE Z .eY7
Project 1
Owner's Name Wt First . MI
AI C le -
.8,4,I
nr0lncl *actress (Street Nema & Number) /7 d S., �' 4v
c„
v4,.. /f/�
Siete //�,,
`//i�
Bu • n/Plat Neme
�7!PRifTl IEft LST
A9vnes0r1 Parcell ..
2151/2-- ea/9
LotBlctic'
5
Plate
•—Applicants%
•
Chv
_Stele
_�Yavy4/2a•
.. ..
Phone
9N1
///
: • ..
•.
Biatna. Phone
Contractor - '
/?Mi✓A" C' 7L/L CD ,.:'
Mdrea
�'SV934/4
City
f/CG'itAYS
ci
Cpn7e/m/ grn-/�,/ 57-ifl.a/
License 0
2,-,/it/✓tc,/��3%,4✓%
av:.„
rt9--
Phone
5:3.5=/7//
Business Phone
a
Psacrloe Work.p
/N� y— // ,�jf&
49,VaW /O�j -/
'Electric
rans
Evaporative Cooler
Hoods
Furnace/Duct'
Miscellaneous
Oryor
Range .:
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000CFM
10,030+GPM
Refrigeration Systems/
-tan Pumps (BTU)
1-100M
.
101-500M •
.-
501-1,000M
1,W1.1750M ' '-
Over 1750M
Compressorli�
0-7HP e
JI/- 4' /
di
0.15HP
15J0HP
30-50HP
50+HP
Gas Piping
0
1-5 Outlets
..
a+Outlets
Gas Fired Heating System
1-100,000BTU ' ' .
'
10u,aD+BTU
t2g at
..,,.:-....:... .. ..l.�., ..
rth
I certify that the above Infor'matron' as'subinitted•by`me.is.t[ue'and correct and fuer,agree that all pro-
visions of laws and ordinances governing thls.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
APPLICATION L
DATE Z .eY7