1985, 04-30 Permit App 00005399 Wtr HtrMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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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
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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