1986, 10-22 Permit App: 00013824 Piping MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
r Project# IC
P,2'/
Owner's Name Last First MI L r
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Project Address(Street Name&Number) �n ,
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City State Subdivision/Plat Name
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Ase s Parcel# Lot Block Plat# 43
225712 - i203 /O 2 i2�
Applicant Address
City State Zip Phone
Business Phone
Contractor ��% Address
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City State Wim' Zip
QG5--- Phone � ., 7-- e,' F
Contact License# Business Phone
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/ ,/1/f/9S k / /D 7-
Describe
Describe Work
Fans Evaporative Cooler ^Hoods E ectric Furnace/Ducts Miscellaneous
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Dryer e . Gas Log Gas Water Htr. Solid Fuel/Wood Stove
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0.10,000 CFM 10,000+CFM
Air Handling Units
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Refrigeration Systems/ , 1-100M.. w 101-500M 501-1 000M
Heat Pumps(BTU)
1,001-1750M w#' Over 1750M
0-3HP 3-15HP 15-30HP 30-5OHP I50+HP
Compressor
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•1-5 Outlets 6+Outlets
Gas Piping IL
Gas Fired Heating System 1-100,000BTU " 10v,,00+BTU
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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 OF , , APPLICATION
OWNER OR Chu, ' �..G�J DATE /0x,2/(6