1986, 10-15 Permit App: 00013772 Insert f
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project#
Owner's Name Last First MI
W 1 LLi AinS r'�t45
Project Address(St t Name&Number)
City State Subdivision!Plat Name
J)1 A\CwtL- L Ke LA r ��1CVia..
Assessors Parcel# i g✓ 1 /—. 0 Lot Block Plat#
Applicant Address
City �i' r ' Stater / Zip/ gi�� PhoneAtt ) Y Y— #a i
/`< v{ Business Phone
//5-5 — d ) 7
Contractor Address
LI', � ,l`,2 .9/d- GL/, gain e
City State Zip Phone
Contact License# _ Business Phone
OCA-t.� //,tlfrkt 'e7.e/,- 457/49&/17 VC-2 /771-rk? ,i
Describe Work 1- %f &/` 47,ce 3 se ,/
Fans Evaporative boolettHoods Electric Furnace/Ducts Miscellaneous
AID
Dryer Range Gas Log Gas Water Htr. Solid Full/Wood Stove
a` cc
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 3-15HP 15-3OH P 30-50H P 50+HP
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10,,,;.00+BTU °
Gas Fired Heating System .° L..�g
r'\\\\\\.Y-✓ s.... -. \'..?
:06ZA3
\ __,---", j"--4-3
A
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.
fee— f-eda s
SIGNATURE OF0 117`Q�i'� APPLICATION U— /j 14
OWNER OR / .DATE