1988, 06-22 Permit App: 88001866 ACMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRI NT;ANDppm PLET,E'ONLY,TH,QSElEARTSOFifHE,FORM YOU UNDERSTAND
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I certify that the above Information, as'submitted b/ me.Is'true'end correct and furer, agree that all pro-
visions of laws and ordinances governing thls.type of work, Including Inspection requirements, will be com-
plied with whether specified hereln'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
C. —2
Pro(ett N 10662
Owner's Name Last Fint MI
tjtern
Project Address (Street Name 6 Number) ' -
762AM., :% /1/0,c
c.,'
Q
State Slate ��
8.:1 ww/Piapl Name 9 p
.�/1� Nom' `sk
Assessors Parcel
075V3 -61(e)4-
LOt
1 _
Bloch
Plato
ApplicantAddress
4tri
J. ! .. .
•
City
StatenP_
•
I. 99..,2/2
prone p -
72_6, �ZU
Business Plane
•
Convector
Add us z,. S 9...:14/
,,1;.,
j,oiltQ/Za
Stale
/y»
ZIP..
79 ,--/
Phone' 5--3.5.::-/7//
Con tact.
RtA SS S LLit &I D E '
N •
/fix/veFic37,4/
Business Phone
0,3sc•Ipe Work
/"-- A---> iu
r/_J✓7/911--e----- /
-an]
Evaporative Cooler
Hoods
Electric Furnace/ducts
Miscellaneous
Crver
. Range '
Ga] Lop"'..
Gas Water Mir.
Solid Fwl/Wood Stove
Ai• Handling Units
0-10,000 CFM
`
10,000+CFM
aevIgor allon Systems/
•test Pumps (BTU)//t/DX
i��0
Z
1-1OOM
flJ /P-7011/,
101-503M
501-1.000M
1,001.1750M -
Over 1750M
Compressor
O3HP
3-15HP I1530HP
30-50HP I50+HP
i
Ge, Piping
-
1-5 Outlets
5+ Outlets
--,
1a,C.00+BTU
1.103,00001U
i
Gas Fired Heating System
th
I certify that the above Information, as'submitted b/ me.Is'true'end correct and furer, agree that all pro-
visions of laws and ordinances governing thls.type of work, Including Inspection requirements, will be com-
plied with whether specified hereln'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
C. —2