1985, 11-27 Permit App: 00009034 Furnace, PipingMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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 OF4
OWNER OR
1
40 APPLICATION (/ `
DATE � 7/
Project N C(,3
Owner's Name - )A 41�(dLast K LF /7 LMI
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Protect Address Name & Number)
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Assessors Parcel ft
Lot
Block,i
Plato
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
A/anCo 4'4-t4' g. A- /d
Adcess
i LOQ/
City
,5"/d0iia-AJzY
State
(2) 4-
Zip
19t i6
Phone
;.3s- 4/97x_
ContactLicense
#
Business Phone
Describe Work
n�''—/
vG1-14-7e J
tom// 'E-lectric
Fans
Evaporative Cooler
Hooddss7/_
Furnace/Ducts
Miscellaneous
SPA -ii T o 1,--
vDryer
Dryer
Range
Gas Log
Gas Water Htr. -
Solid Fuel/ Wood Stove
Air Handling Units
0.10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6 + Outlets
Gas Fired Heating System , /
1-100,000BTU
1060;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 OF4
OWNER OR
1
40 APPLICATION (/ `
DATE � 7/