1985, 06-21 Permit App: 00006155 Heat Pump i a iL,
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# /_,155-
Owner's Name /Last ] First iciMI ct%
Project Address(Street Name&Number) 9
City State Subdi ision/Plat Name .
L `/, i-i6 R C KS.on! 1)c ce
Ass sors Parcel# 4/.._
3.J!E L 6—r ./ Lot Block / Plat#
Applicant/ - - Address i ,J
City fn State Zip / Phone }
Business Phone
Contractor ‘`) Address,
City/ State Zip Phone �
f'-
Contaatt.,_ License# Business Phone
tfi ._d ,-i-24 :L P -rte 5,:1„k7 - ° /✓✓
Describe Work /J -. ..v7---i- r
Fans Evaporative Cooler Hoods EliEtric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
Air Handling Units 0-10,000 CFM 10,000+CFM
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU) j r 04°2
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-3OHP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10,,,00+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.
SIGNATURE OF APPLICATION 4 /OWNER OR ,y? '7 t -tc4,,ye z4: DATE /' /