1986, 03-07 Permit App: 00009935 Furnace, Water HeaterMECHANICAL PERMIT -APPLICATION'
tifY..
PLEASE PRINT AND. COMPLETE ONLY 064,PAFTS
ORKSHEET
E FORM YOU UNDERSTAND
certify that the above information as submitted by`meistrue 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 arApermit 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 APPLICATIO �.
OWNER OR L �?fl%`_.�G ,. DATE T ;G
Project 0
Owner's Name Last First MI
74/ 2), L--71/7 "&h'7 1 1i.3ViZ//'s _Al
Project Address (Street Name & Number)
//77-C— '/-'- ,'/1/1//i<6-'/10/ CX7,
City
A/°n/ir.
State
/14-g
Subdivision/Plat Name
6.7uCA l Uj i v 04c, --.S I tc-p0
Aaaessorepa
�G
- [ N `
,.,
Lot Coq
j
Block (
Plat N
A!/
Applicant
Y1
Address
City State
Zip
Phone
Business Phone
Contractor
/9ii/V. /L -74/7-Z— L-/7
Address /j
,moi . IL jIC 4/`,,.4'W
City f% �c
%l�0 4 — -
State /�/J
Gc�/'
Zip -
. e°79 -
Phone ,
.�C3/-; —/7/7
cont t
,V/9 / y
License N
Business Phone l
IF, -/ V. -33.8 7
Describe work
Fans
Evaporative Cooler
Hoods
Electric Furnace/[Suets
Miscellaneous
Dryer
Range
Gas Log
/y/Wateerj-ltr.//�/ .
111 f -� 4 -J e4`1111/7/.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Ref ri gerat Ion Systems/
Heat Pumps (BTU)
1-100M
101-600M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
1530HP
30.60HP
60+HP
Gas Piping
�/ ��
1. 1-5 Outlets
B+ Outlets
Gas Fired Heating System
1-100,000BTU
10v :AO BTU : �^
certify that the above information as submitted by`meistrue 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 arApermit 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 APPLICATIO �.
OWNER OR L �?fl%`_.�G ,. DATE T ;G