1986, 05-20 Permit App: 00011303 AC ► -
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
AO St eE?
Project#
i/fir)-3
Owner's Name Last = = First MI
Project Address(Street Name&Number)
-77 . (P 9 -7/(:Ai/C71-410--- ( •
City State Subdivi on/Plat Name
ALKrAST
Assessors Parcel# X6-543 Lot Block/ Plat#
Applicantatt/jete
� � � Address
� ,.�/'�/�-. 7"YLKZ!
Phone . / .j ✓L 1
City J State Zip
42.ziLieiet. �,ia__., 99,-2-* 9. -, ,
BusinesI Phone
Contractor —N • Address—,
-- �� 1z)• 83. `--3 7)7
City State / / Zip Phone#97y7
i License# Business Phone
��,1
Contact /
!Le—Y(1 —a/ -- c3 73, ki t-
Describe Work
- / // - 6?-7-i om .
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 Systems/ 1-100M / _ 101-500M 501-1,000M
Heat Pumps(BTU) �i7`/ `I �G ,
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
i
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10k,,;,000+BTU
/J
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 oor 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.
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SIGNATURE OF / APPLICATION ='
OWNER OR �'l1'/�t� . l��'�� DATE r c� '