1987, 12-14 Permit App: 87004200 Gas Line Air TestMECHANICAL PERMIT -APPLICATION WORKSHEET
PLEASE PRINT AND'.COMPLET,E ONLYhTH,QSEtPARTS OF,THE,FORM you UNDERSTAND
:.y
I certify that the above Information as submitted by.me.ls'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,permlt does not presume to give authority to
violate or cancel the provisions of any state of local laws.regutating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION /a _/y _37 7
DATE
Protect
WI First
OwnorbName cmenea6t-c, Sc.o -r
Project Address (Street Name & Number) R O S R4
tiV
my
3PIcet^'r
Siete "
w
Subdivision/ Plat Name
(2491-
LM
Pmbg-
Block
�
I-\/�
Fiat N
Assessors Parcal 1675 n �/1 ....66 71 1
Applicant....,
, -may
C!
Address
.
".
7 to
Clts State VP,
c/°p j2rJIC I L,✓4 ,'.i:..,9.?Z/2--,
Phone
77-2 2 kO7
Business
Phone
;gnlractor • ..
Add eaa�s
/,���
City `J�C//�f'/f
/�,//�yI//+
State n//�
G/'J��-
I
9pG%�//J�/�/�
/ //i/i"'-
Phone
�J/
�29.��// /
a"f—�
/LicenseN�
Contact RU S S Li t ni JD F_
//�-
I ��✓r�/���373'�
BWIness
Phone //
i .
Descrlba Work(4-c 2 zes > oA/ ,FR'i 3-7-/'� �
Gl�� /y✓
No. T CC J11- 7
a �� r yam.
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Misnllaneoua
-
Dryer
Renge-
Gas Lop''
Gas Water
Htr
Solid Fuai/Wood Stove
CFM
Ay- Handling Units
010.000 CFM 110,000+
aetrigeration Systems/
-bmf Pumps (BTU)
i-1WM
101-SOOM t
501-1,000M
1, 001.1750M -
Over 1750M
Gcmnrossor
0-0HP
315HP -
1530HP
30-50HP 150+HP
Gaa Piping
not luta
_
6+ Outlets
Gas Fired Heating System
1-100,000BTU t
10v400+BTU
:.y
I certify that the above Information as submitted by.me.ls'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,permlt does not presume to give authority to
violate or cancel the provisions of any state of local laws.regutating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION /a _/y _37 7
DATE