1986, 10-10 Permit App: 00013537 Mechanical Fixtures It
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project#
Project# /35. 7
Owner's Name `�� 72eJ t MI
Project Address(Street Name&Nuumbec� �
i+E . t42If9 5e-1-14 re,
City State Subdivision/Plat Name
a1-a Pt cAJcL QP pa rtii i r 1Q r ra ce . 3 RD
ra Parcel# 2151/2- — 15(fq Lot /. BI&k 6 Plate
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Applicant Address
City State Zip Phone
Business Phone
Contractor 'Address
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
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
Gas Piping 1-5 Outlets 6+Outlets
Gas Fired Heating System 1-t00,000BTU 10v,�.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 OFAPPLICATION //—G/ -f
OWNER OR .DATE