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1985, 04-30 Permit App 00005399 Wtr HtrMECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND �S 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' 9 CATION � OWNER OR �� ; , l(b' DATE Projeu^M-�� Owner's Name Fir MI Project Address (Street Name & Nu Zr D City te r Subdivision / Plat Name er /k/c/ arcel�) Assess6rs Parc?,,, Vi' Lot Lf Block& let PM Applicant Address n D d City State ZIP Phone Business Phone Contractor _ Address D D City Stets ZIP qq Phone 7 /� / Con t License# Business Phone Describe Work Fans tive Cooler pRanNg." Hcods Electric Furnace/ Ducts Mlscellane0u9 Dryer Gas Log Gas Water Hfr. o, 6T - Solid Fuel/ Wood Stove Air Handling Units 0-10,000 CFM 10,000+ CFM Refrigeration Systema/ Heat Pumps (BTU) 1-100M 101-500M 501-1,000M 1,001-1750M Over 1750M Compressor 0-311P 3-15HP 15.30HP 30-SOHP 50+HP Gee Piping 1-5Outlets 6+ Outlets Gas Fired Heating System 1-100,OOOSTU 1W,d00+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' 9 CATION � OWNER OR �� ; , l(b' DATE