1988, 06-22 Permit App: 88001875 FurnaceMECHANICAL PERMIT IT*IOATION'WORKSHEET
PLEASE PRINT AND COMPLETE ONLY.� H S ,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 notal The
of9lrocali laws:�egulatingdoes
construction oet a performancauthority
e of
to
violate or cancel the provisions of any st
construction.
SIGNATURE OF S APPLICATION 4�1 7_2— g r
OWNER OR -r .DATE
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Cwnor's Name Last First... MI
Pro)oct Address (Street Name 6, Number).* "'"� •.
r city state I • ' Subdlv1slon t Name
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Block. Plat t
navessors Parcel M Lot._ -
Address '
� Applicant
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�— city
State
7.6
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Bwlnen;Phone
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', Address
t.Onlractor • / ,/ n d�D �/
� � �/►'��� �U � � SCJ f/FYf 7 (!'
raly ! Stale `.ZID�ff� � n Phone
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Con tact License 0 BusinessPhon�.�`=i
0,33crlbe Work - (� / �-Q ._ VAlf4E_
- Evaporative Cooler Hoods Electric Furnace/ Ducts Mlaeellaneow
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Range : , . Gas Water .. Mr.Solid Fuel/Wood Stove
Gas Log'
i Dryer
0.10.000 CFM 10,000+ CFM
� Air Handling Units
_ 501-1,000M
r a.31rigeratlon Systeme/. 1-t00M 101-500M
a>�t Pumps (BTU)
1.001-1750M Over 1750M
0 30-501 P 50 + H P
� .3HP 315HP 1530HP'
i rnmpressor
i
- 1-5 Outlets 6+ Outlets
Gas PlPing
- 1-10D,000BTU G 10,,a,3+BTU
Gas Fired Heating System
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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 notal The
of9lrocali laws:�egulatingdoes
construction oet a performancauthority
e of
to
violate or cancel the provisions of any st
construction.
SIGNATURE OF S APPLICATION 4�1 7_2— g r
OWNER OR -r .DATE