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1987, 05-11 Permit App: 87001425 Spa Heater MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND AS Project# /`fr2�..� Owner's Name Last First ,- M "L� CQ1.cG1_—tl4 S ik-Ley, - . b Project Address(Street Name&Number) //4'/V / , Cit State Subdi ilio Plat Name Assess Parcel# �/ 1— 1 e Lot 1//k Block (• Plat#,`�vim' v Applicant C Address City State Zip Phone Q t2.oR '4, 7 —'(ov0 Business Phone Contractor Address City State Zip Phone Contact License# Business Pho CO P25—)0-19---7-1\1\ ��ius i p t.5-3 r)1'9 7 , z-6,-2)---.) Describe 'i / Fans Evaporative Cooler Hoods Electric nace/Ducts Miscellaneous Dryer Range Gas Log Gas Water H Solid Fuel/Wood Stove Air Handling Units 0-10,000 CFM 10,000+CFM Refrigeration Systems/ 1-100M 101-500M 501-1,000M Heat Pumps(BTU) 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 15-3OHP 30-5OHP 50+1-IP 1-5 Outlets 6+Outlets Gas Piping Gas Fired Heating System 1-100,000BTU 10u,:,00+BTU �j 0-1' 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 -7(l61 OWNER OR .DATE