1986, 05-15 Permit App: 00011039 Furnace, ACMECHANICAL' PERMIT APPGCATION WORKSHEET
PLEASEPRINTANDCOMPLETE'ONLYTiSE,PARTSOF'THE' ORM YOU, UNDERSTAND
I certify that the above int ormation:as'`submltted:by`me is true and correct and further, agree that all pro-
visions of laws and ordinances governing thie type of work; inciuding 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.locallaws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION����
DATE
Pm,ect e 11 e3G
Owner's Name Lest ' First ,Lir ',: • MI
SC.#dEieP ///r/M IlE,€,v iP;, ..:....
project Address (Street Name & Number)
N //09 .ams ,2g)
City Slate
9
Bubdlval /Plat Name
..9yh/4//{E.n
Assessors Parcel W•..
1h5th .4
.Lab
Block 4.
Plat
Applicant A' ..
cail
Address -
City
'State' -•
'DD`:•- '.J�j
Phone 124—P/17
Business Phone
...
Contractor :.
Add es.
.: ,%�AO: dep,<-gr96
CI
rdOiA/A
Stele
.• DD/1/2-- .
Phone w3 ////
✓ /Le
lOWA//79 fG�`49/1/4/e/47,2741.
IAib .
Bsin ss Phone / /
Describe Work - r
Fans
Evaporative Cooler
Hoods
ElectrIc Furnace/ Ducts
Miscellaneous et/LF
4-FA7Me/ /64
Dryer
.flange '
Gas Log •,• , •-
Gas Wate Htr.
Solid Fuel/Wood Stove
Air Handling Unite
0.10,000CFM
/
10,003+ CFM
Ref lgeral Ion Systems/
Heat Pumps (BTU) -
1.100M `$ A/..47,�.OX -
_ -• .2-71-94/
, 101-500M -
.. -
5O1-1.00OM
,1,001:1750M
Over 1750M ,
Compressor
0-3HP
3-15HP
15:10HP'
3650HP
50+HP
Gas Piping
•1-3Dui lets _ '• 1-''' ' .
., .,.. ,.,. .., ..
a+ Outlets
Gas Fired Heating System'
10.,:.00+BTU
i1.0D e act Pe
Q.00 -zJ 7 '.0.
20, 00
I certify that the above int ormation:as'`submltted:by`me is true and correct and further, agree that all pro-
visions of laws and ordinances governing thie type of work; inciuding 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.locallaws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION����
DATE