1987, 05-08 Permit App: 87001422 AC •
a � •
MECHANICAL PERMIT APPLICATION'WORKSHEET
PLEASE PRINT AND COMPLETE ONLY, 9,-1 IPARTS O.VOE,FORM YOU UNDERSTAND
IProject" I 1.12.-2
Owner's Name _� B� last First MI
U/&%.ZA-'6. A11 el
Project Address(Street Name&Number)
Cly State v 1 SubdlvlaionlPlat Name
7aP/e /E i Vootir"' �tVD N1n
v
Assessors Parcel 0
„..1 � Z So L Block / Plat N/6006
V
Address
Applicant
--541/1• '
City Stale ',0 „p I Phone
I 1-,2F ' . _ ,,,,,-
,,-• — /z/
r • . Business Phone
Contractor Address
B/9�✓/✓ 1 -L/,� Ge . ,'Z'•l 9,.?4/ '
City
ma -� Stale Zip :, • Phone
\/ yI`/.L -114-1
A -1 rVAZ9,--' J"
. =-/7//
Contact_ License M BneesPhone
'‘...)?7/e/A/ /1//friS1141/d/
Describe Work /4/3 7 /9/ie
die ,O/7;.0 ,e--
Fans
Evaporative Cooler Hoods /' , Electric Furnace/Ducts Miscellaneous
Range Gas Log ', Gas Water Htr. Solid Fuel/Wood Stove
Dryer
0-10.0O0 CFM 10,000+CFM
Air Handling Units
I501-1 ,000M1
r Refrigeration Systems! 1-100M ' 101-500M
Heat Pumps(BTU) _
1,001-1750M Over 1750M
`
0.31-4130.31-413L //1/1-V 3-15HP 15-S0HPI 30-SOHP 50+HP
COrTIP(eaa0/ -Ze if ./
1-S Out1sU e+Outlets
Gas Piping „ „ , .
1-100,000BTU 5 1 O..COO+BTU
Gas Fired Heating System
21/—
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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 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 OFAPPLICATION 3:-4 -- �,r�
OWNER OR Aae,,.. .4./...,,, .DATE