1987, 09-29 Permit App: 87003319 FurnaceMECHANICAL PERMIT=APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE`ONLY�Hf; Sf?ARTS QF THE CORM YOU UNDERSTAND
• I certify that the above Information as.submitted,by'rne,Is/true`andcorrect 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
OWNER OR
APPLICATION
DATE ? _61' 7
Project e
Owner's Name Last First MI
�r 0,1(A1/046" fj1, v 40(A.
Project Address (Street Name & Number)''
/) /02 IZoofL.l vF-.. Iz°
Coy
S too KA -A.) E
Stats
W ta!
Subdivision /Plat Name
Assessors Parcel 0 g
/
IL:
/'
SI ook
Plat 0
Appllcanl
'
City
„S„"0/6411
at
(.n) A
,21p
' : .4 g i :6.
phone
7-z 5/ 5 3 ‘ Z
Btelnaes Phone ‘02,0
.zy
Contractor
/3,�,V.s//)C Z- Ce,1 ...
Addrags
tY1.,r y.34/
City ,t _
Ste ' _ /
.215—'"Pha+e
..7 /7//
Contact
R u S S L >v 0 E.
Llosnse 0 •
V7---
Business one
,r
.3/1.vis/, i-.37cf'
Describe Work
S 7;44-4- iv6 v o << 7i )
Fans
Evaporative Cooler
Hoods
ElectricFurnac,!tucts
Mtet>lttaneous
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 ll54M
Compressor
03HP
3-15HP
15-3OHP
30- HP
50+ HP
Gas Piping
-5 Outlets •
5+ Outlets
Gas Fired Heating System
1400,G008TU
.4 _ W tom/ uZ. ea.- 7 j
10v.. 00+e'r'.' •
• I certify that the above Information as.submitted,by'rne,Is/true`andcorrect 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
OWNER OR
APPLICATION
DATE ? _61' 7