1986, 06-06 Permit App: 00011724 AC , a
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project# / / L 72-V 2-V
Owner's Name Last -�J- Fi t MI
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Project Address(Street Name&Number)
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City State1 `� '� Subd' ' ' n/Plat Name
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Assessor arcel# .✓ / Lot 3 Block 5 Plat#
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Applicant Address
City State Zip Phone
Business Phone
Contra r A"cp2.4....ttif Address• .f ' (a 710Cit L�""�`^ StatO ipQf� 6 Phone
Cont d"' 't License# Busidhone
.r ��L�( � -cam' �i i'n u tf E - 19,3 N tC:)"0-1.44—k_eet_tji---Describe Work C� ..-L�.eit I �`�,�i42i i_toetet.44 (-„6„..(2„
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 -�� 1100M 101-500M 501-1,000M
674 W Heat Pumps(BTU) � VIVO
O�- 1,001-1750M Over 1750M
Compressor
0-3HP 3-15HP 15-30H P 30-50H P 50+HP
1-5 Outlets 6+Outlets
Gas Piping
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 t-T, APPLICATION6' 6 _e‘
OWNER OR .DATE