1986, 07-01 Permit App: 00011926 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
ierCe
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 /60€
APPLICATION /7.0.?,70
DATE
Project 6 / /Q2,
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Owner's Name Last First MI
Ye
Project Address (Street Na e & Number)
[3/ 02_ e- /Fe )
City
S�d� �
State &subd/
i PS lat ame
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[!2
Assessors Parcel 41 /75t + O5G Z
Lot
Block,
Plat sr
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractorress
----fd._ 12415-7 7-a --/9T
,0a' o h ";-�4
7.5)0e, /4_ J�—State
Zi /,
5 �� ?,✓Cotact
_ , /
/S
License M
Business Phone
Describe Work / //
/ " / /
� / (
�1/ j/ i C�fI
Fans
Evaporative Cooler
Hoods
Electric Furnace/D ucts
Ianeous
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
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System v
1-100,000BTU �-----
10v,�00+BTU
C..-"jt3-e....-zza.i.v210/�� 4, i � � ��
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 /60€
APPLICATION /7.0.?,70
DATE