1985, 10-10 Permit App 00008312 InsertMECHANICAL PERMIT APPLICATION WORK HE TND
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF T UNDERSTAND
3 g
S FR
MI
Owner's Name
Project # Q / -
Project Address (Street Name & Nu r) �1
Subdivision/Plat Name
City 141(F'O t•..f ST NO E
I Plat #
I State
Il
Lot
Assesors Parcel # oL /t, 42— 2C22-
IL
Applicant
1 State ( ZIp
city � e/`
t y-%e) 7
Contra
`�-- �Sthte L., I Zip
Fans
Dryer
Air Handling Units
7 7
License #
lth-S7- ,6- - /9 y�•�'
v orative Cool
Hoods
Address
I Block
Phone
Business Phone
Address
/ 7
Phone
� 03 —/e / 7
Business Phone
�3 is/7
Electric Furnace/ Ducts
Miscellaneous
Range
Refrigeration Systems!
Heat Pumps (BTU)
Compressor
Gas Piping
0-3HP
1-100M
1,001-1750M
Gas Log
Gas Water Htr.
Solid Fuel f Wood Stove
I0-10,000 CFM 110,000+ CFM
101-500M
501-1,000M
Over 1750M
3-15H P 115-30H P
1-5 Outlets
30-50HP 150+HP
6+ Outlets
1-100,000BTU
Gas Fired Heating System
10 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
ntA/M R nR
APPLICATION
DATE i °%° /1J