1987, 04-14 Permit App: 87001002 FurnaceMECHANICAL 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 local laws regulating construction or the performance of
construction.
SIGNATURE OF 2, //�j
OWNER OR
APPLICATION
DATE </ / `- c7
Project# 1002,{'
Owner's Name Last First MI
llAf 4 i r
l >�
Project Addrese (Street Name & Number)/
‘74/1. /4//2 ,a,,,,4tat ...,e•City
State
-� A+r <'74, /. Jr
Subdivision/Plat Name �
U1071 Vf'l &`L r' j 2e75 -
°Assessors Parcel#_ (21'0 /
lG
Lot
Block
Plat #
Applicant -
/J.e/6227)3- ,/,/�c4„ c/ .� .
Add ess -
3/ j262?.1.2 622-re-s0u_
S
City q
?.t.l;e,ti_
State
LtJZ.,.
Zip
99.-;=/ 2—
Phone
- —
—
Business Phone
1/4-5-13,9-- 217.?
Contractor ��/%,7�� //��"� ,,,, "� // .[
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Wate 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
15.30HP
30-50HP
-
50+HP
Gas Piping
1-5 Outlets6+Outlets
/ .
Gas Fired Heating System
/-100,000BTU / 90-0
10,,,:00+BTU
//�� %i
.0 9,-t 19'
2 `E• COd
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 2, //�j
OWNER OR
APPLICATION
DATE </ / `- c7