1986, 10-24 Permit: 0013845 MechanicalMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETPQNLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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 \ c� i/ �'� DATE 1 t,� 1
Project M ` Q1
/ �J
Owner's Name
Last First
MI
- /-7-
ZVA
Project Address (Street Name & Number)
City
state
Subdion/Plat Name
42 v
Ass ors Parcel M � / � /
f'—Ir`rlTY
Lot �
Block
Plat #. _
Applicant
Address
"P QC�
`C. /Co G S c
City
State Zip
Phone
if
co3
�f
��- %e�
Business Phone
Contractor
Address
City
State Zip
`l el -� -/
Phone
- /r 0—cy n
(Al
U
C Z 2 - 2 _7e
Contact
License N
Business Phone
Describe Work
1�
V
Fans
Evap&i4eccAier
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/
1-100M
101-500M
501-1,000M
Heat Pumps (BTU)
1,001-1750M
Over 1750M
Compressor
0 3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10.,:.00 + BTU
'YO
111yEC
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 \ c� i/ �'� DATE 1 t,� 1