1987, 04-21 Permit App: 87001131 AC "
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Owner's Name t First MIP , J
P Forts MRS C.1 yd e
Project Address(Street Name&Numb
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CityC) State Subdivision/Plat Name
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Assess Parcel q / ik2J a! Lot Block Plat#
Ap Address
City State Zip Pho
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Business Phone
Contra or Address
City State Zip Phon
Cont - License# Business P one
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Describe Wor j- re
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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 01-500M 501-1,000M
Heat Pumps(BTU) Q coo
Cl\--62444Art.)
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-3OHP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10‘,,,300+BTU
Gas Fired Heating System
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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 oor 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 Q APPLICATION L
OWNER OR <,'(. .DATE '// --'--1 / h v7