1986, 07-18 Permit App: 00012274 MechanicalMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE.PRINT AND COMPLETE ONLY:. H S ,ARTS OF TH CORM YOU UNDERSTAND
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I certify that the above Information as submitted by`me,,Is true and correct and further, agree that an 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
OWNER OR C /<r �.r DATE
Project #
Owner's Name Last
First,.; :
MI
r1 }m4. N
Project Address (Street Name & Number)'
city
State
Subdivision /Plat Name
Assessors Parcel#
Lot-
Block . f
Plat
Applicant
Address
City
State'ap
- - •
Phone
"Incas Phcaa
Contractor
Address
City
State
Zip'
,.,,
Phone
1<,4A%E
Contact
License #
Business Phone
FG _77' N r
Descrlbe Wor
n
//
,y t
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log` ;'
Gas Water Htr.
Solid Fuel/Wood Stove
0-10,000 CFM
10,000+ CFM
As, Handling Units
Retrigeratlon Systema/
1.100M
101-500M
501-11000M
Heat Pumps (BTU)
1,001-1750#
Over 1750M
. �F .,
.
0 3HP
3-15HP
1530FiP'
30 50HP
60+HP
Corepressor
1-5 Outlets
6+ Outlets
Gas Plping
1-100,0006TU
10v,:a0+8TU
Gas Fired Healing System
�✓ L
/ACL'
I certify that the above Information as submitted by`me,,Is true and correct and further, agree that an 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
OWNER OR C /<r �.r DATE