1985, 10-11 Permit App: 00008016 Furnace(16
') MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY 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 granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of loc- aws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
_ DATE APPLICATION /e5/
/ 3/f
Project # Fok
C C/
Owner's Name Last First MI
Project Address (Street Name & Number)
e / 97/
City_.
State
Subdivision/Plat Name
Assessors larcelll(IC7i 2
Lot
Block
Plat #
App • /
�/-�n
Address
City
State
Zip
Phone
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License
License
/ 6/ ,%w
Business Phone
Describe Work i
.....tede4e.e.,
Fans
Evaporative Cooler
Hoods
Electric Furnace/ ucts
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
15-30H P
30-50H P
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 granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of loc- aws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
_ DATE APPLICATION /e5/
/ 3/f