1986, 02-28 Permit App: 00009844 Gas PipingMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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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.
SIGNATREOWNERUORO DATE CATION `��_�6
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Project M
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Ownerl Name
La9t �Z
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Pro ect Address (Street Name & Number)
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City
State / _
W� L
bd vision I Plat Name
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Assessors Parcel M Z
Lot ,
BlockPlat
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Applicant
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Address
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City
St t� Zip
Phone
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Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License M
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Units
0.10,000CFM
10,000+ CFM
Refrigeration Systema/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor 7
77P
3-15HP
707p_
30-50HP
50+HP
Gas Piping
1-5 Outlets
5+ Outlets
Gas Fired Heating System
1-100,0008TU
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.
SIGNATREOWNERUORO DATE CATION `��_�6