1985, 10-30 Permit App: 00008433 Piping Y
MECHANICAL PERMIT APPLICATION WORKSMEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# `4 77-1
Owner's Name Last First Mi
E— frN101(
Project Address(Street Name&Number)
• /S1t3 191 4uP _
City State Subdivision/Plat Name
61 "'P.N..
Assessors Parcel# Lot Block Plat#
2. ', c-41 GL1 'V
Applicant Address
City State Zip Phone
Business Phone
Contractor Address
H- ,�c E-Imo-#T7 M C. t 0408 STI± AA) -
City State Zip Phone
Contact License# Business Phone
Describe Work
Fans 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
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
0-3HP 3-15HP 15-30H P 30-50H P 50+H P
Compressor
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10,,,Z.00+BTU
Gas Fired Heating System
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.
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SIGNATURE OF _ APPLICATION M' ]l '��
OWNER OR Gil .DATE
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