1986, 04-24 Permit App: 00010709 Gas Log, PipingMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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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.
OGNAR O OF `� 1S �,
OWNER OR /''c.�
APPLICATION , Q y 2 L
DATE T
f5
ii,56
Project # 16 70
Owner's Name 17Last First / MI
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Project Address (Street Name & Number ✓,/)"
14 /6/c2 -1_/22{o
City
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State ,
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Subdivision/ Plat Name
/4LLLC2sr` PAP [Si
AsseGora Parcel # 5 // _ V.L-�/
/TL -
Lot 2
Block Z
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Con ct aYC.///t',C
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Add es9 i . JO o d f/
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City/ GJ
State
Zip6:2
Phone
Confect
, et2-ems
License#
/ raj TT/—/F7L-N
Business Phone
Describe Work / g17-/-/ /JCS //
l�r�—(4z-z� %� neo i'✓/7 /t//�+
Fans
Evaporative Cooler
Hoods
I
Electric Furnace Duots
Miscellaneous
Dryer
Range
Gas Log \ 50
Gas Wate H7
Solid Fuel/ Wood Stove
Alr Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+ HP
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Gas Piping c, 6GC.L�-�Lxi
1-5 Outlets
3
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10,,000+BTU
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.
OGNAR O OF `� 1S �,
OWNER OR /''c.�
APPLICATION , Q y 2 L
DATE T
f5
ii,56