1986, 05-13 Permit App: 00011079 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 d/G�
APPLICATION
DATE (_ J 7 `d 't<
Project# I I 17 79'
/
Owner's Name �� MI
Project Address (Street Name & Number
1R 3 78 s 14.- .. -7
City /fcLr)
State
✓11.
Subdivision/Plat Name
Assessors Parcel #
Lot
Block
Plat II
Applicant
�. ��9/)
Add en
N rccn� d
City
� „
State
1---1,1,9
Zip
y a z 7
Phone S J 5--- 7S3i
Business Phone
5 3 S`"— 7333
Contractorj�
/int.7 otn (A`�// 1a
Address
Cit y
State
Zip
Phone
Contact
License #
Raz Pki_ )q// 3
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Wale Htr.
Solid Fuel/Wood Stove
Alr Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,003M
1,001-1750M
Over 1750M
Compressor
0-31-1P
3-15HP
15-30HP
30-50HP
50+HP
Gas Pipings
1-5 Outlets
6+ Outlets
Gas Fired Heating System
G
1-100,000BTU
712.
10,0:00+BTU
fs--b /ev
-3 spa h.tc,
•P'
g a? &,zo A--;.a7t-t-
6 rS w4 tali
C 73�
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 d/G�
APPLICATION
DATE (_ J 7 `d 't<