1987, 01-06 Permit App: 87000080 Furnace, PipingVS
•
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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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
)./�`�c .DATE i'_ b 7
Project # 1/i/T/'Y cro
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Owner's Name y� Last 7 -� First MI
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Project Address (Street Name & Number)
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u. >2 rd 5
City tate (f Cf 7 / c
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Subdi I Plat Name
u i Ew 1457 1ST
Assessors Parcel # 564 / / 9
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Lot Block6
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Plat # SFI
Applicant
Address
City
SPO jckl-),�._e__
State
( L 44-
Zip
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Phone
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Business Phone
Contractor
tii /(c i' > n 14-'(7 j 'I- in? C"-f)tr (+ PVC–
Address
6 5 b I fiJe-e.ti I
City,
5 Po %i4+k,Liz_
State
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Zip
C)?2- a cp
Phone
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Contact
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License #
h)-4 c c H/-- 17 c J ?—
Business Phone
DescribeAork
(I CIL- I 'ti) (,e -1-S FUq? --C--e ( A + /'t_ 1= Lt g ,.;ter¢ --z.-+
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
3-15HP
15-3OHP
30-50HP
50+HP
Gas Piping
l
1-5 Outlets
6+ Outlets
Gas Fired Heating System
a 100,000BTU
10,,,J..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
)
APPLICATION
)./�`�c .DATE i'_ b 7