1987, 07-13 Permit App: 87002176 AC .. *-- MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# 'Z 1
( ,
Owner's Name C Last Fir f MI
Proj res(Street Name&Number)
E, 13_-7&s ( I--
Ci State Subdivision/Plat Name
/411 LOQ' 1.--t)4
Asses s Parcel# ff (2,, __ilk Lot Block Plat#
Applicant /,.:_,c----Li- _ -A ,1':; Address
City State Zip Phone _
Business Phone
Con actor l Address
Ci )k rd(A A- i i / /+ & Ti1tJ - a l�7/4) __oil 0.0/4 Ai2f
y/� Sae Zip Phor —
f/�41luJA- 7`1(2/ 7 c�`-. /cue)
Cont-. .r Lice e B hone
AM OilM- - cg3A)/
Describe Work / s cJ Lam. c --- 1 C;4 -- C ,
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
Air Handling Units 0-10,000 CFM 10,000+CFM
Refrigeration Systems/ !ly1-100M
101-500M 501-1,000M
Heat Pumps(BTU) 0444") QJ; 00e
1,001-1750M
Over 1750M
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 10v,�00+BTU
(S--O()
5 ----
C ��
1 ...._91-" ...---
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 oor 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 / .
C -r ( S- 2
OWNER OR ( DATE �/