1986, 06-17 Permit App: 00011814 AC •
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
70 II- �
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4s
Project# /76/
Q/17_
Owner's Name First MI ]—
Zwea
Project Address(Street Name&Number)_
City State Subdiv' ' /Plat Name
Assessors Parcel# G:_t~F J1/`1 — a 8 r 3 Lot Block e Plat#
Applicant ,44.40iiiieAddress
�h . . //7/9 ..
City State Zip Phone
orf ja m e)o 1� 4?-.,)- — r�
Business Phone
Contractor Address
-— /'_is h T.,a Idi Oa<+-_ /9. -6, 37e7
City State I Zipt9�� Phone y-//it )
Contact License Business Phone
‘: 71.S-1Ql <9-xa -G1a'-ci' 7J/
Describe Work /t l7
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
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor 0-3HP 3-151-IP 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� � �it.���d—`— DATE APPLICATION /�/�',
OWNER OR