1986, 10-22 Permit App: 00013822 Furnacef
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
*AN
Project # /302 2
Owner's Name /�/ //// //�/�//�jLast /j [Aj First�j/, MI
Project Addresstreet Name 8, Number) /c�
C ,' cC/.,57/ !/ , d
City
S f e'/1A—Al
State
lY (-
Subdivision/Plat Name
Assessors Parcel #
Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
bc/� ea A / Al / A-
Add ss
,, X 51 7 4;--/07"
City
SPditifitis-
State
a) 4
Zip
99 7
Phone
J'34/- __"
Contact
12 l1k//'
License #
ald 3 32/11ai4e-f-6*4 / 70 -HZ
Business Phone
,_5--3 V -- 4/97j ---
Describe Work
ECEty E
Fans
Evaporative Cooler
Hoods
ectric Furnace/D ;.,
0 C T2 1986
/ is
i
Ilaneous
Dryer
Range
Gas Log
as Water Htr.
li<
ttly
uel/ Wood Stove
E.
F' VION
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
15-3OHP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6 + Outlets
Gas Fired Heating System
1-100,000BTU
10v,L00+BTU
,�� /5 A --2C1 A2/ -,c ---e. -____
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
APPLICATION /i/IV{.6
DATE