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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