1985, 06-10 Permit App: 00005862 FurnaceMECHANICAL PIERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE C)NLY 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 ntirg of a permit does not presume to give authority to
violate or cancel the provisions of any stat f local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION
DATE ..**"
Project #
Owner's Name Las % First MI
Project Address (Street Name & Num er) �/�/
/ G'""' Jam- zo'-71.'
City
ems' JC ri.7.-,C
State �/
Ce- '"j .,
Subdivision/Plat Name
essors Parcel #
(524/81
Lot
Block
Plat #
Applicant/` 7.--
Address
City
Sta —�'-
Zip
Phone ./y //
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
.7'Zi�c�t��
License #
i f E_ / %u
Business Phone
Describe Work
_y (,may' /��'i
/'.-74—e.//i',4<-e.'
/4,;-/-.0.V:// ,,,e7;&1.-4-1-4-1, e.//i',4<- E 4t,' �s/'�e. e.„(71‘,..--2...,--
."Fans
Fans
Evaporative Cooler
Hoods
Electric Furnace/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 -151 -IP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
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 ntirg of a permit does not presume to give authority to
violate or cancel the provisions of any stat f local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION
DATE ..**"