HomeMy WebLinkAbout1986, 07-09 Permit App: 00012068 Space HeaterMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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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
OWNER OR
,„(
APPLICATION 7 .....
DATE
Project # / '2 D %_E
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Owner's Name Last First MI
AA �eJIe,�- heirm A ifs
Project Address (Street Name & Number)
A) ! it/ .,1Ji, 110W
City State ,Subd�i
69 fJe X44 cry v4& .
n/ Plat Name
LJPPcll?TuiUc T y
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Assessor ParcelM / - 75V,
Lot
Block t V
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contr ctor
Contractor lid( pr- (j P f-= x711 e"--
Address-�-
- . 7/ v i /V D/A- .4
City
Stat
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Phone n
Cont
yit0.,a,4-0
License #
_ AM QUM4 I3a3 aC.,
Business Phone
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Describe \ ork` r,,. _
Lt J .A1- 2_ /(, t C, 1. _.1- -ti ( � -SPD,, a ,
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Y
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Units
0-10,000 CFM
10,000 + CFM
Refrigeration Systems!
Heat Pumps (BTU)
1-100M
jt4 "e,,- r'`
101-500M
501-1,000M
1,001-175010
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+1 -IP
Gas Piping %„.„,et,-A�
�- 'CLEC. `u-rjrj
1-5 Outlets
6+ Outlets
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
OWNER OR
,„(
APPLICATION 7 .....
DATE