1985, 10-18 Permit App: 00008166 Insert MECHANICAL PERMIT APPLICATION WORK$MU T
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
IProject#
�
Owner's Name Last First
Geed/641,11
Project Address(Street Name&Number) 'AA
,'.>z3.2 s State#' r Subdivision/Plat N\a%me �i �Q
City / L' 7 (li L fes-'1
Site(fid�� I Block ` Plat#
Lot 11
Assessors Parcel# U-CO 4
ci'2, - I Address /�
Applicant ig /j. ��4../ /� X231 r s,t;a/L�IJ
v`/j/i/I��"
City State Zip Phone
_c1e AP• g.• A 99.2i a 9
Business Phone
9..22 •.2 423 4%r.! G oil
Contractor I Address
City I State I Zip Phone
I License# Business Phone
Contact IL
Descr rk
A I n :ropsw r
Hoods Electric Furnace/Ducts Miscellaneous
Fans Evaporative Cooler i
Dryer Range
Gas Log Gas Water Htr. Solid Fuel/Wood Stove
C 0-10,000 CFM 110,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100M
101-500M 1501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
1 0-3HP 3-15HP
115-30HP 30-50HP 150+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10v,:..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.
• APPLICATION /O r ,
SIGNATURE .DATE
nwnlFR OR