1988, 11-17 Permit App: 88003796 FurnaceMECHANICAL PERMPT-APPLICATION WORKSHEET
RTSO THS foRM YOU UNDERSTAND
PLEASE PRINT•AND COMPLETE ONLY
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Owner's Name
Last First
MI
a2--6 , J()
IProtect
Project Address (Street Name & Number)
City
Sok
Assessors Parcel N
Applicant
City
Sate
Stale
Subdivisl at Name
Blod(• Plat
?2 GYSo
Stillness
Contractor
c!ry (sea
.vim ,A y
,,/4/ Q'
Contact. &I fE I L.84/4g/, , ' 4/7
tZ E o c P-tK-//' 'EX --
Electric
_Electric Furnace/duets
Address
Ph" .5a.-=/7//
Describe Work
Fans
Business Phone
Evaporative Cooler
Hoods
Dryer
Range
Gas lop
Lias Water Htr.
Mi oetleneous
Sola Fuel/Wood Stave
0.10,000 CFM
Air Handling Unita
10,000+ CFM
Relrigeratldn Systems/
Heat Pumps (BTU)
1.100M
101.500M
501-1,000M
1r001.1750M
Over 1750M
03HP
Compressor
3-15HP
1530HP
30-50HP
50+ HP
1-5Outteta
Gas Piping
1-100,000BTU
Gas Fired Heating System
6+ Outlets
10'0:00+BTU
03"D
Jfwfaitt�r . ,: a�^
I certify that the above Information as submitted•by me Is true'andcorrect 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 bereft') or not: The granting: of a.permlt 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 �' v J APPLICATION / 7— (/
OWNER OR .DATE