Loading...
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 ..**"