1985, 08-26 Permit App: 00007087 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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 ofs, - laws regulating construction or the performance of
construction.
SIGNATURE 0
OWNER OR
APPLICATION
DATE ��/` ��
Project #7 077
C
Owner's Name Last h/j // f First MI
Project Address (Street Name NuJmber) f/
--.)' 4/L Na�(C. Nu (/ et)lL
City
State
Subdivision/Plat Name
Assessors Parcel #Lot
-2_----:7---6-0-- f -31'-“-)5
Block
Plat #
Applican
//2
Address
City
State
a
Zip
Phone
Business Phone
Contractor
Address
City
State
Zip
c
Phone
Contact
License / `6` „ 4')
Business Phone
Describe Wo , A,
( _ E" 47i- i 6479.
/75- 17keg,z-Zef
Fans
Evaporative Cooler
Hoods
ectri ace/Duct
Miscellaneous
Dryer
Range
Gas Log
Gas Water Httr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3H P
3-15HP
15-30H P
30-50H P
50 + HP
Gas Piping
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 ofs, - laws regulating construction or the performance of
construction.
SIGNATURE 0
OWNER OR
APPLICATION
DATE ��/` ��