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HomeMy WebLinkAboutAPPLICATION - 05-00416 - 4459 W 1000 N - Gas Line10/26/2005 08:40 2086243774 HOUSLEY PUMPS INC PAGE 02 rr _I~C'1 ~ ~4~hltl hc. Iha~ ~'. d p'iease complete the ent~ Application! Xf the ~u~sstioo does ~appry till ito NA for non applicable NAME _.~~ ~ PROPERTY ADDRESS ~ ~5~1 L~~~tl_.1~ ~Zf emu ~e~ ~c~l3r.~lvlsloN ____ _ _~ OS 00416 ~ZequY~ted r -! ~ECI~ANIC G1s I,lllV Itlsp~cl. - RdS. 1~Iad Cu. Mechanical Conhector's Names 5~[`C~f.[~!1_.s~~.,.~Ausincsy lvamc: H~a[S~„T ~~5,,~ Address_.jdJt~ f` ~'lilCun ._~.~~City_~State ~C~ •-_Z-p~S~~ Contact Phone; (3I1~1)~„",,~ 7? ~ ~3usiness Phc~»e: {.~ok-)~- 3 _7_7 a- Emdil__1J ~ ~ F'ax o'2u - 1601 ~, _~ 7 ~ _ MrcLAnical Estimate $ ~'~ (Commercial/:1'llulti Family Only) FLaCTCIRES & APPLIANCES COUNT (Single Fwr~ly Dwerlirg OnIY) ~1ir Conditioner Aat1Y Fan Vents ~__ Mange Hoed Vents Roilcr Cook Stovd VcKtts Decorative (3as aircplaces _ _ _ Urycr dents Evaporative Cooler _ Exhaust or vent ducts a;czuRU.~ ~44~~ rr~.c~/ r6~~ . ~,^,,. Fue) (gam) piping fixtures or appliance oatlets - +G~'~ ~~ `~`~ 0 Furnace !'urnace/Air Conditioner Combo Heat Pump Incinerator ______._ Yoot Heater Heat (Circle all that appl ~ ~Ua,,%`Uil Coal Fireplace Electtic ~... Mechanical Sizing Calculations rnu~t be submytted with Plane ~t Application Point of Delivery must be sho~-n on plans. ` Si~t~ll:~~e of Required! _X~~ ~ s s . LicCnst: eurnbcr llato Ths Ciry oJRexbarg °.e nernrif fen schedale is the' xum~e uY rc<qu[rad Sparc Hester __.. Ylnil Heater Iduhc~ 5