1986, 11-05 Permit App: 00014007 Piping MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# ///00-7
Owner's NameL t First MI
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Project Address(Street Name; umber)
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Cit State Su ivision/Plat Name
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Assessors Parcel# OS 5e// 4 041 1/- tto
7-10-I( Block_ Plat 7o$ 4s
Applicant II <_.. Address
,-\ eirz_,,/ . (. .L7-, QN1 .-\D\ 1 S--ry fit
City State Zip Phone _
-�c . lam, \i,..) r\ C1 C1 Zs01 ''-S<°\ — 5(- `v
Business Phone
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Contractor \� ----� Address
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City c-- State Zip Phone )\
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Contact License# Business Phone t,)
Describe Workr ft /8'/86
1 0\ \ i\L`cam C x \ S\ I C` 1 S \I CA2.„•
, Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor
0-3HP 3-15H P 15-30H P 30-50H P 50+HP
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10 ,,,00+BTU
Gas Fired Heating System
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 herei• or not. The granting of a permit does not presume to give authority to
violate or cancel the rovisions • - y state of local laws regulating construction or the performance of
construction.
SIGNATURE OFj7 (,�/\ , \.-f APPLICATION (J S --
OWNER OR 1 .DATE