1985, 11-04 Permit App: 00008512 InsertMECHANICPPERMIT APPLICATION WORK•IRUT
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
�s
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
OWNER OR
de-G4./21e./),
APPLICATION
DATE ��'� C
Project N '
Owner's Name Last First MI
/f'4,c.fe,<" % 67< 4 /C' L ,
Project Addressg(Street Name & Number)
f! 7(2ce2- ,PIZ-L L y 1J/v7
City
cneAA/C
State
,475A
Subdivi Ion/Plat Name
I-A""'•1C�-TOM S c) /{errei-iAisen,
Assessors Parcel #
/E5i/(/- i/hci-
LotBlock
2-
Plat*
Applicant
L'/ A/g L . v..)ZiP T
Address
_ f //3/ 1 7n.7)(e-c)Zt c_
Cit Q _
/v ,74/L/7J
Stated (�
Zip
99a0
Phone
T,;;Z 6so5/
Business Phone
Contractor
klizi 7 m o1i/r
Address
"
City
State
Zip
Phone
Contact
License M
Business Phone
Describe Work
/N S 7,1« e7 eusro "el 54‹,e__/- 1 L ,,-2/----
?/ _Fans
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
VIrS
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems!
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30H P
30-50HP
50+ HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10u, X00 + 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
OWNER OR
de-G4./21e./),
APPLICATION
DATE ��'� C