1985, 09-10 Permit App: 0007586 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
22000
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 con" -
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 G�/l ��F�iG1/4,5DATE /
Project # --75-,� `,'
�Y
Owner's N e/�/� 'nay Last / First `MI
Project Add s (Street Name & Number)
(/a Co? 3sio, `�'4'�
City
4
f%L�
State
ti)4 9;la2eLPA-IV0ViC-
Subdi ion/Plat Name
v / FES
Assessors Parcel # 6 II -5 !�71Ce
C �e/6
Lot
Block J
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
Ivo 4e0 �- �`12d - A --/C
Ad ,.--aJ--/ -9f 4✓T
lcl )6v /l T i
State W �-
Z9 ; / a ip
Phone — 41 9'
Contact
License #
Business Phone
Describe Work
tS 4e -//Z
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
iscellaneous
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
1-5 Outlets
6 + Outlets
Gas1-100,000BTU
Fired Heating System
�'
10.,Z;00+BTU
2 kC e --e 4 6:'0,--24 f- drf
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 con" -
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 G�/l ��F�iG1/4,5DATE /