1986, 06-06 Permit App: 00011620 AC .
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project* //tap '
Owner's NameLast Fii MI
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^ th<No N
Project Address(Street Name&Number)
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C' State Subdyy�' ion/Plat Na
Assessors Parcel# ^ l/L
15 . _/`7 - iff 7 Lot Block 1 Plat k
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Applicant Address IL
T tQ - 0E--c-S - 1-4-.-4-75-L.k-S1
Ci State Zip Phone
/.) 't °tr4 f---- S1-•‘-- CoQ
Business Phone
Contractor Address
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City State ' Zip Phone
actipisa License# Business Phone
1---el—% kAiA14 U.-".E. -S 1 C-.. 3 26_ SI.--c.
Describe Work L
_ N" L---- .0*** --
Fans Evapor tive Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor 0-31-IP q _V 3-15HP 15-30HP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10v0300+BTU
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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 �` ` APPLICATION r --J
OWNER OR `.DATE