1985, 08-27 Permit App 00007211 Gas PipingMECHANICAL PERMIT APPLICATION WORK HEETTNDERSTAND
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM
Owner's Name
Project Address (Street Name & Number)
City
1-
Ass(ors Parcel #
Applicant
/ .<_/� V
Contractor
City
Contact
State
State
State
License #
First
„e 6-C
Subdivision! Plat Name
Lot
MI
Block
Project N 72
Plat #
L-32/P A
r?
Zip G / 7
Zip
/ �/�
�j 95 /� (/mod eO7 /// F� 4y C U
Fans (/�J
Evaporative Cooler
Hoods
Dryer
Air Handling Units
Range
1
0-10,000
Gas Log
CFM
101
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
1,001-1750M
Over
Compressor
I 0 3HP
3-15HP
155-
/
Gas Piping ,r, 4
1-5 Outlets
Q-g % tl� v 0 f"
Gas Ired Heatin�� 5g Syste
.
1-100,000BTU
,�r
.1.5 o
��
Phone —
Business Phone
IAddress
Phone
Business Phone
LJO/
Electric Furnace/ Ducts
Miscellaneous
Gas Water Htr.
Solid Fuel/ Wood Stove
10,000+ CFM
M
501-1,000
1750M
30HP
30-50H P
50 + HP
6+ Outlets
10v, 00+BTU
I certify that the above information as submitted by me is true and co ,
inspection requirements, type of work, includingq ents, will be visions of laws and ordinances governing this
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
OWNER OR
APPLICATION 1, DATE _ to-
J C