1985, 12-19 Permit App: 00009201 Mechanical Fixtures MECHANICAL PERMIT.APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project#
Owner's Name Last First MI
Project Address(Street Name&Number)
_S // 1t>//4/.m r -
City State Subdivision/Plat Name
-tom- A/ _
Assessors Parcel# Lot Block Plat#
Applicant Address
City State Zip _ � Phone / „ / ff/
Gf Business Phone
Contractor Addr
/t / , /E'SeT ,aevi".34
City �� State At ZIP
74- 0, � Phone me/7//
Contact License# Business Phone
Describe Work
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
I
0-10,000 CFM 10,000+CFM
Air Handling Units
(9 ,
Refrigeration Systems/ 1-100M /�� 01-500M 501-1,000M
Heat Pumps(BTU) ,y/
1,001-1750M Over 1750M
0-3HP 3-15H P 15-30H P 30-50H P 50+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10,,,.00+BTU
Gas Fired Heating System ///4a ; 5 Z5(A/4t
471/
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� APPLICATION
OWNER OR `'` " , -c- ' f-moi' DATE