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�