1989, 04-12 Permit App: 89000929 ACMECHANICAL PERMIT- APPLICATIONWORKSHEET
PLEASE .PRINT.AND'COMPLETEONLY
•
RTAS OF,TH ,eORIYI YOU UNDERSTANDy
J' y
Prosect N
Owner's Name Last First MI
,AbeA(7 J t it
Project Address (Street Name & Number) • •• ,
922-4,.: NlaCoAJ
city
S lie K.4. Al
State
Go -4-
Subdivision/PI ams
' ` S
nssessore Parcel N �y J_{,� /� - /.7.il
/ r l
Lot.
Block..2.
Plat N
Applicant.. 'V�
T79 -
.Address
City
State st
ap .
phos.
•
n„-..:..:_ * ..4.Stelnea
Phone
Contractor
Addrea
city
IY,
State
Stat. ��,/
p9`949,-.phos..s':J.
=/7//
Contact .
R S S c-E.t %o E.
License...7._:,
13,1.4,ir/,c-/37::914�'T
Phone
1/
Describe Work
NS -z-,4-Le.. 2 Go ..1 p
#4t
Fans
Evaporative Outer
Hoods
Electric Furnace/ducts
Miscellaneous
Dryer
Range
Gas Lop` ;•
Gas Water Htr.
Solid Fuel/Wood Stove
AO' Handling Unlls
0.10,000 CFM
10,030+ CFM
Refrigeration Systems/
Heat Pumps (STU)
1-1.00M
101.-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP vv
%3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets Y
6+ Outlets
Gas Fired Heating System
1-100,momTU
16.„,-.00+611./
.
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
APPLICATION
DATE
y./2--8 -