1986, 11-05 Permit App: 00014137 InsertAct
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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 OFA -1
OWNER OR ‘-v`:r.7---
APPL
APTEICATION J, 5"-14
Project0 14) 37 1, /
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Owner's Name /'Last First MI
C" 1/2/er jr
Project Address (Street Name & Number
S 2 6/1- Ne ect L,n fir .
City
1/e .- &let /e
State
Uak- 5 /
Subdivision/Plat Name
Ti rh c3Fr_ t_,4,� E i
Assessors Parcel p ^ c/t 2 -0,/
T7 4`-`f��
Lot 2_ Bleck
Plat p
Applicant file
filer J-) t
Add ess
,1� //
'iv/ // $ Hee', <,...-ni Pr
City/State
erctc _
yt,c, ,
Zip
99c3 7
Phone
72 8-- 9 3 7S -
Business Phone
53V- (S3 /
Contractor
/9/741. o"- 6_ 'Inc_
Add ess
3/b V 1< ,e«r_.
City�_ /
{/{
State
kV .
Zip
Ci -C12-0/
Phone
3 2 ,-- '6 -yd -
Contact /
jO w e A!J,es.� .e. *. -
License It
6,fa/�/t2c _i-/ 77 kr
Business Phone
/ /
Describe Work /_ �/� 61744/ /
1 y/LI� le /71/4 6- file f4ce XI
y/--
r-er
Fans
/
Evaporative Coole
Hoods /
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
c
Solid Fuel/ Wood Stove
_ref 54eyr
Air Handling Units
0-10,000 CFM
1. ------
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
5014,000M
1,001-1750M
Over1750M
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 ,� Jl
pAG'_
10w 00+BTU
-;"'
E C EIVE
IT' 3V t 21306
SEcEIvb
....
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 OFA -1
OWNER OR ‘-v`:r.7---
APPL
APTEICATION J, 5"-14