1986, 07-10 Permit App: 00012163 AC -.. — .
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# / _f
JJ
Owner's Name Last First MI EEff
Project Address(Street Name&Number)
A/ _3/C 1/.5710_..,
City State } Subdivision/Plat Name
4)0 ilea> L C�G'--
Assessors Parcel# Lot . Block Plat#
Applicant • Address
2,2,A-7 ik,,,,__ , je.; etiti— /1/ .3i 1/4.5/0-
City State Zip Phone
Business Phone
Contractor s_ -) Address
- /lP-• .e. �5. .76' 7
City State Zip Phone ,'/
Contact License# Business Phone
)/ -//// 0)(,,c) a-e-Z - — 3 7,21/vi
//Describe Work -`c-- r V/ iL i / 4 Z./C- e/
4—
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) "'`
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10v,: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.
SIGNATURE OFmac' ) APPLICATION
OWNER OR a -- C a .DATE 76/Z