1986, 01-30 Permit App: 00009539 Furnace, PipingMECHANICAL 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 pro g ons of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION
DATE
Project e ,5. 3 6/7 -
Owner's Nemet C S F MI
R, ON
Project Address (Street Name S Number)
S' 3D-5/ —Z der re -e A .
CI
20/4-e
4 �0arcei
State /
OA(
Subdivision/Plat Name
l
A cors Parcel a
Lot
Block
0
App j� a KCJ� L/ �.•e/Ns7
��//� (I� //,',,
i�) D�� /Platt
Atldreas/ * /7/i `( (i W I -
/l
Cit /
State
ZI
Phone
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact•////,(�
//��
B eines Phone _ .
Describe Work .. .
Fens
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel /Wood Stove
Air Handling Unite
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+HP
Gas Piping2-
15 Douala .3
6+Outlets
Gas Fired Heating System
/-100,000BTU
Q
tQ,,;,00+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 pro g ons of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION
DATE