HomeMy WebLinkAbout1987, 02-18 Permit App: 87000377 AC a
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
11PLY 130
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Project# el_ _j,
Owner's Name Lastn ' ' rs7' MI
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Project Address/ /0 c:2CJ(Street Nam'e`&Number) �jf
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City, 1 State Subdivision/Plat Name
Assessor Parcel# Lot Block Plat#
Applicant Address
City State Zip Phone
Business Phone
Contractor Address
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Cont. ' ' . LICeLnse
#
4`r`('t/�'1 N LJ J l j Businhone
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Describe Work,. ' ` --r
ok-& CALf2i,.4.,' Li,„ 0,6_ Q-b,..J:d.,,,,,,,,,
Fans Evaporative 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) L
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
Gas Piping 1-5 Outlets 6+Outlets
1-100,000BTU 10,,,,;00+BTU
Gas Fired Heating System
160 _
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
OWNER OR YiAL
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,4/� .DATE /FS r�