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1985, 08-21 Permit App 7032 Piping` MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND XI2, 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 APPLICATIOCVj�� OWNER OR v 4��a/ DATE N� Project a .7 Owner'3 Name Wt Final Ml 3f Project Address (Street Name S Number) 1-7 'f'�j / �r- CII State Cv� , Subdlvls qn/Plat Name DRal�,j ArD 7-0 Cs%2E�/JACP Assessors Parcel M Lot Block Plat 0 APPlican Add�reys, City State Zip Z10 151— Phone Busineae Phone Contractor Address City State Zip Phone Contact License M Business Phone Describe Work Fans Evaporative Cooler Heeds 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/ Heat Pumps (BTU) 1-100M 101-500M 501-1,000M 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP Gas Piping 1-50utiets 6+ Outlets Gas Fired Heating System 1-100,000BTU 1O.,�00+BTU 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 APPLICATIOCVj�� OWNER OR v 4��a/ DATE N�