1986, 04-11 Permit App: 00010654 FurnaceMECHANICAL PERMIT APPLICATION WORK$HEUT
PLEASE PRINT AND COMPLET.E 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
APPLICATION LI r 1
DATE
Project It !e/5' /-
�iJ`�
Owner's Name ^Or_�—Last fret MI
V
tNName
Protect Address (Street 8'Nummbberr
S-S1—L, F'
-
CI State
a- C ^_ _
NA
Subdivision/Plat Name
Assessors Parcel e
Lot
Block
Plate
Applicant
II
Add ess
c-3 `8 v....)
,,
`�- � . �_.p
City
Stat
Zip
— 44 t
Phone
3'Le —S:10
Business Phone
Contractor
Address
City
State
Zip
Phone
_
T1M
Licensee
tAit72-.1 l..1...1%) ‘-‘1 L- I c"...)i c.
Business Phone
2— `CS ti -a
Descrl0 Work
c.--(2-4—SC—
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
G'__-.-
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr. ,
Solid Fuel/Wood Stove
Alr Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
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 -
1-100,000BTU
10,,;,00+BTU
U
Zf v _
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
APPLICATION LI r 1
DATE