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, - .
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Project Address(Street Name&Number)
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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
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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