1987, 07-09 Permit App: 87002186 AC ! 1
MECHANICAL PERMIT APPLICATION`.WORKSHEET
PLEASE PRINT AND COMPLETE ON.LYh . S ( R I,S OFipTHE FORM YOU.UNDERSTAND
Project 0 / ( 36
Owner's Name Last First MI
C400FIC'F-` . J E•. ).Jt (.
Project Address(Street Name&Number) ' !
IN -7 0 "7 (A. :4 L Al 7` R
Coy State Subdivlalon/Plat Name
Assessors Parcel M ' -- Lot.. . . .BtodtPia!M
Applicantt
J,.. Address
City StateL . L- ,-, .,-.Zip Phone
Business Phone
Contractor Address -
City State Zip Phone
Contact License 0 !• like Phone
je
Describe Work
.z_, yj 7:-/-1-4— Al/2. C iV0('7'/Cilii :6,—(2____
Fens Evaporative Cooler Hoods Electric Furnace/ducts Miscellaneous
Dryer Range Gas Log' Gas Water Htr. Solid Fuel/Wood Stove
0-10,000 CFM 10,000+CFM
F Air Handling Units
Refrigeration Systems/ 1-100M ' 101-500M 501-1,000M
Heat Pumps(BTU) .
1,001-1750M ' • Over 1750M
• -
O.3HP 3-15HP ' 1530HP 30-5OHP 50+HP
Compressor
A6/-in+c;;X tfJj le --,2( l v,- 7 ,
1-5 Outlets
6+Outlets
Gas Piping '
1-11b,000UTU 1 Q.,�00+BTU
Gas Fired Heating System
I certify that the above Information assubmItted by rne.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
DATE c
OWNER OR .1.-''�--� °f7?�� � l Y7