HomeMy WebLinkAbout1986, 10-08 Permit App: 00013583 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
OWNER OR 4
APPLICATION /
DATE /� rA
Project®
Owner's Name mst FirstMI
/5/c'/ 214 5c_07-7---
Project Address (Street Name & Number)
37a9 /✓ )(Z.( /r
City
State
Subdivision/Plat Name
Ass ors Parcel #
Lot
Block
Plat e
Applicant '.</J �(. /(/1 /e ]�
�r" It f //M,t/ I'/(/
Add ess /'/�r�//
7.12 ,�-7 ( ?l/r!" !/f1��
City
j.C7c 4fAh-
lir/,,
Zip
6/ 1 2c7
Phok
� °o
L/may -/Y40'.5-
„,/
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
f in %
License p _ /
�C /` /// 6/9/5 /&-G
Business Phone
Describe Work _
rn S in // AA/6:' 6-//f / u/1/ib'e/-�'
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
1530HP
30-50HP
50+1 -IP
Gas Piping t.//
1-5 Outlets
B+ Outlets
Gas Fired Heating System
1-1 W,000BTU /
1W,;.W +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 4
APPLICATION /
DATE /� rA