1986, 08-25 Permit App 00012899 Wtr Htr MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project# i n 3/}
Owner's Name Last z."" _ First MI L-�7�j
I t i 6 t, i) 7/2/c h_.
Project Address(Str t Name.2_Numbe)
,'� 2-L Yri6 ,Q Ar
sty State40/3 Subdivision/Plat Name
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Assessors Parcel# / - 5stg+ g J s Lot Block Plat#
Applicant (lyJj /L7// Address
City State Zip Phone
Business Phone
Contractor Address
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City State Zip ii Zip Phone
Contac) Lic nse# Business Phone
1 /� All QUA- 1 r3a3 g
Describe WorK t
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. �! Solid Fuel/Wood Stove
0-10,000CFM 10,000+CFM- ' -
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-3OHP 30-50HP 50+HP
Gas Piping 1-5Outlets 6+Outlets
Gas Fired Heating System 1-100,000BTU 10",L00+BTli
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. i' t so'Y APPLICATION
OWNER OR DATES/��