1986, 10-24 Permit App: 00013826 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ON. LY�TsRCSE,�P!ARTS,OF,.THE FORM YOU UNDERSTAND
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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 thls.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 lj).vx,�g
DATE /!�
Project t
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Ownor's Name %.1/17/7--)1,
Project Address (SSttreet Name & Number)
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State
8ubdlvl I i P Name
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Assossors P ..ei dn....,
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Lot
Block
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Applicant,�%/��y-
Address
City
State
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Phone • 9-22 f,7
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Business Phone
Contractor
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Address
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City
State.
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Phone
Contact
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License0 ✓
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/Bl
netts Phone
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Dascrlbe Work rL� �J ,/ /^
%91.R �+ z, e ,/,L. 1-16'eAr [.Cts
Fans
Evaporative Cooler
Hoods
Electric Furnace/butts
Miscellaneous
Dryer
Range •
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handfing Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
•seat Pumps (BTU)
1-100M
'1,001-1750M
101-500M
501-1,000M
Over 1750M
Compressor
0-3H P
3-15H P
15-30HP
30-50H P
50+ HP
Gas Piping
1-5 Outlets
6+ Outlets
b/
.-Als Fired Heating System
1-100
0008TU
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M
1a.,,;,00+t ru ,[ NA/
L—''
aCi22 ]9RR
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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 thls.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 lj).vx,�g
DATE /!�