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1986, 04-22 Permit App: 00010646 Insert MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Project# Owner's Name Last first MI DUI A.) MNtu, • Project Address(Street Name&Number) Nei /0 City State Subdivision/Plat Name OE J6 pfl LS tl- c-t- erRa-Y c_m5 Assessors Parcel q 'I _ '+6-2- Lot Block Plat# Applicant Address City State Zip Phone Business Phone Contractor Address City State r Zip Phone Contact License N Business Phone Describe Work F IEopcJIAce IINS ctrr' 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/ 1-100M 101-500M 501-1,000M Heat Pumps(BTU) 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 15-30HP 30-5OHP 50+HP 1-5 Outlets 6+Outlets Gas Piping Gas Fired Heating System 1-100,000BTU 10v,;..00+BTU oz, 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 OWNER OR DATE