1986, 10-13 Permit App: 00013588 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PR,tNT•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
( 7‘
APPLICATION /0��%�
DATE
Project# /3s88
Owner's Name
�+ e First MI
/frilvr<e---
Project Address (Street Name & Number) /� /� Q n
( e'c/\ i-- /i)..9
OC3�� /`-�
Cit
/riefiri
State
szv_
Su vision/Plat Name
mo oites--s
Assessors ParcelM/ 2-5S �V - VO3
Lot 3
Block 2.
Plat 45
azedin
City .51° -1//
State ,fii,/)�
Zip g/
j/'jj^!a
Phon� Ll/97 -
Business Phone
Contractor
v t
/l Q�IXJ �/�`�I� / ! `JV 4,-/
Address
377,67 .___2(.,
City
i Al ,-cam__
State
Zip
/�
Phone—
5 �3/ 777
tact
License M
4_1
Business Phone
Desai
/e,e4Y-
, ?- CSC r)'; - - - -- - • �-,,Z.,-&_,,
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
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 . %
I-------
1"100,000BTU""
10v, AO+BTU
�-, fl a,, Com/ %..... ,...
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
( 7‘
APPLICATION /0��%�
DATE