1986, 03-04 Permit App: 00009958 Mechanical Fixtures r•
-
/ • MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# 1P758
Owner's Name Last First MI /��
c� /29/TN \g..4_1
.-
Project Address(Street Name&Number)
76 5. 16e/‘-'Y Y\)1JGe.—
City _ State Subdivision/Plat Name
Lot Block Plat#
Assessors Parcel#
Address
Applicant
City
State Zip Phone
Business Phone
actor Address
1 .-es-� 4 ,/ C - 7f/C 4. 'V G) •
..•City7 Zip Phone
Con aLicense# Business Phone
/Describe Wgrk
Fans / G Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. • Solid Fuel/Wood Stove
I 0-10,000CFM 110,000+CFM
Air Handling Units
Refrigeration Systems/
1-100M 101-500M 1501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
I 0-3HP 3-15HP 115-30HP 30-50HP 150+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10u0;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 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 0f c.s-N i /� APPLICATION ��j
OWNER' OR _'��,� � �`J % y„�4,-- .DATE
1l