1986, 03-20 Permit App: 00010130 Gas Line MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# f n 13 0
Owner's Name L Last First MI ff V1
J -e�/�e n i-i'o fe. Are. , 7
Project Address(Street Name&Number)
N' loy t4,/ i ',-
City State Subdivision/Plat Name
Spo AQ n 2 , ,s% IV IJ I arL1l r4( , 011.-1\U4 fir( _
A ss r GGI�I�reel ,,
1eLot G Block
—7Z,
Plat M
Applicant Address !J
Chet_i-..f i-e i-- //fD 3 / f -vio:�>City State Zip Phone
VoA a,, e c-e./Q-_s- 97 z a.‘
Business Phone
Contractor Address
/—o U k 57`a,A- 5.e_ t vie. e 4%"/�✓`&? /—'a. cf L,,e
City StateZip Phone
Soa/� 4 e "„4, , pPae6 7p? 6/- 9,5 f
ntact License# Business Phone
FOO(L..S t I(4 PI-4 / I
Describe Work
1/91 a 1.----e ;/ cts. p /n.� ( ,(P /7
r) Co'1--C,
Fans
Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
G.-----
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 15-3OHP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System
1-100,000BTU 10.,,: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 OF APPLICATION
OWNER OR .DATE