1985, 10-14 Permit App: 00008030 Piping t
, I MECHANICAL PERMIT APPLICATION WORK$YEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project# '.r,30
Owner's Name /� ,�),��+y Last F st ) �7( L JCfGtnt� �L�
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Project Address(StrrjCeett''Name&
/cNNumber) `
e --(0 .�3 �i
44o12 )
Stat
SubdivisionName
te / rgor ��Nrs 4sessors arcel# Lot Block
Plat#
2- 543 - 12_2 l� 1 2-
Applicant0,Vzilict) , Address
¶, y -t•,- 1 Zi Phone.
o,, zips_ _ 94g - 07,E
/ Business Phone
Contractor h / `J 4G-L—i)
Address
p • ( State Zip Phone
Cit
4,i ♦ n�,,, /�
. tact `� `C License# Business Phone
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Describe Work 4_ , j _ �� C� )
,4_14 ,
Fans Evaporative Cooler Hoods A/Elleccttric urnace/Ducts _ Miscellaneous
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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
0-3HP 3-15HP 15-30H P 30-5OH P 50+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10,,:00+BTU
Gas Fired Heating System
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 /V') / / APPLICATION /E)41/5 -'
OWNER OR ��1 A � 1. ....:&._,Gu-'' .DATE �S