1986, 01-29 Permit App: 00014621 Space Heater MECHANICAL PERMIT APPLICATION WORKSHEET
' PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# //�f n
Owner's Name Last First MI 'T�JL,
Al o 'G.-4( I- R u ei ivc F If.
Project Address(Street Name 8,Number)
-t<- W14 'u7 7?6/1 a S Cl/f3
City State Subdivision/Plat Name
S/"dii'A/t✓E. w A . UAi r vet`'S tr y R A-C-E
Assessors Parcel# 265 4 et — C `O / Lot f— ` Block 8 Plat# Az5
Applica t S ` Address
i ty Stat Zip Phone .,
Business Phone
Aa--.-st.()
Contractor Address
City State Zip Phone
Contact License# Business Phone
Describe Work
Fans E porative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000 CFM 10,000+CFM
Air Handling Units
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
/GY3, CCC, �'
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 "� I APPLICATION /
OWNER 0' �. . _ _.-t - - - ' ii‘..._ !-- - DATE /7"P/t�