1986, 05-13 Permit App: 00011080 Furnace, Water HeaterMECHANICAL 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
r�//i/�
APPLICATION
DATE
#
"(Project
Owners Name Last.� e Flrr MI
0.
Project Address (Street Name / /& Number O ///^^^
.. 3 - �j-/ .ef/elt"
City State
Subdivision/Plat Name
Assessor arca!#
Lot
Block
Piet#
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
//�y�
Address
City <4i� -�
%/G/r�os�
State
l�./y,�
Zip
9 9;z d 7
Phone
�i`.P �- 7 3 7
Contact
License #
Ariz PQM 1 LI i -5"?
Business Phone
-2
Describe Wo/r(
././00-1 / Ci'�/N _ 9a' 1/44"
,;�/
.ham✓.1!N
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Wate Htr.
'& in
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
1-50utlets .
�(
6+ Outlets
Gas Fired Heating System
1-100,000BTU ,
10u,:A0+BTU
/ C' / v.
:3 b D brs 6'
9 C b /d-cl 1--i "Vt
/m•
6 12 tii� r'vv /e
3 3�--b'
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
r�//i/�
APPLICATION
DATE