1987, 12-02 Permit App: 87004117 FurnaceMECHANICAL PERMIT-APPLIUATION`WORKSHEET
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YOU UNDERSTAND
PLEASE PRINT ANC.OMPLETE ONLY\ FORM E S
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Project M . 1 1-7
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pwnor's Name 'P� TD , - / ��
Project Address (Street Narnr d,. Number) ' (�/ �l
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city State Subdlvlsion/Plat Name I
1*,Lot:.. Block Plat M
j Assessors Parcel M � ��
Addreda r
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City State
G ,~ Business Phone
Address
Contractor
State : Zip
� City �Phone'
�
Contact_ . Llcenae 0
LA S S tL—(LA of -JD F
I Caiscrl tJe Work
r Fans EvaporallveCooler Hoods
Range . ' Gas Lop`:. ..
Dryer - .
0-10,000 CFM
Business Phone
,e 0,-/ Cry
Eieotrlc Furnacel Ducts
Gas Water Htr..
10,000+ CFM
Air Handling Units
1-t 00M 101-500M
R?Irlgeratlon Systeme/
Heat Pumps (BTU)
1,001.1750M Over 1750M
C.
0-3H P 3-15 H P 15-30H P :. 30 -SOH P
Compressor
1-5outtete - a+ outlets
Gas Piping
1-1(10,tXY?BTU 1Qa, =+BTU
Gas Fired Heating System
Miscellaneous
Solid Fuel /Wood Stove'
501-1,000M
50+HP
pro
I certify that the above information as submitted.by mels true and congectoiIon furthrequirements, that llbel om-
visions of laws and ordinances governing this:'type of ,Mork, Including p
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 lawsregulating construction or the performance of
construction.
SIGNATURE OF APPLICATION Z—�7
OWNER OR ,DATE /