1987, 10-01 Permit App: 87003373 Furnace, PipingMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
SF -2
BMX/30 5a/
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
OWNER OR
1
APPLICATION
DATE
Project # JJ3 2-73
Owner's Name Last First MI
0(.4 (4.)',,,,,',,, I" -i i\ L I\'' % ; / .46,
Project Address (Street Name & Number)
LtI-‘I. ,x 1.�_".y,-, .i..
City
c'...1-,,,
'iF'"-A.1
State
Subd'vision/Plat Name
�`'ly�'J ST �o
Assessors Parcel #
Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
.S;•'(? j 714 Fr 2 / i'A.�-•
Address
City
State
Zip
Phone
/
Contact
License #
Business Phone
Descrlbp Work _ )
Jr
Fans
Evaporative Choler
Hoods
Electric Fu ace/Ducts
Miscellaneous
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
ping
Gas Pi In
1-5 Outlets N
6+ Outlets
Gas Fired Heating System
1-100,000BTU r.2',..a
r7
10.,,,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 OF
OWNER OR
1
APPLICATION
DATE