1985, 08-21 Permit App: 00007194 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAN
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 a com-
plied with whether specified herein or not. The granting of a permit does not presume to give autriority to
violate or cancel the provisions of any state of local laws regulating construction or the perform nce of
construction.
SIGNATURE OF^ �, A/ APPLICATION
OWNER OR tea/ C-Gctlo DATE
Project # 7/ q�
`i
Owner's Name liaLast First MI
fie: F %l .
• Project Address (Street Name 8 Num
T /'hr7/) /
City State� j- � /
+ .41 -rt v gar� j1.en-r3
Subdivision/Plat Name ccC
N.( ( q t 4i Ln l-A6`)(R 1� 0i)
+e (LEO
AC. 5C
Ass ors Parcels C/
Oq9- l—o(o3 (
Lot
t-
Block
C.
Plato
Applicant
tivbc i
Add ess
fib. 3 37n 7
City
State I
Zip
Phone
Business Phone
Agq//70--eAEL-
.3Llr
Contractor
fe-Aa+97�) t- ��
Address
gD. E. .57u 7
City
�l
State.Zip
c�a .
gqi-�n
Phone
ijgt>- P7d .atici,
3-,)-r9
Contact,{ pa_ � �o
�J�?/Y /c%vh�2)3-o/-.Se-AP.-S.P
License e
z»Ali
Business Phone
48i-,,m-e.,b.340
Describe Work 0 f q n
\ .I -NI .CI�wiz?,
Fans
Fans
Ev por
Evaporative er
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
tarn,
eI/Wood
//II���/'�rJ}}
6twie�n/
Air Handling Units
0-10000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-103M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-3OHP
30-50HP
50+1 -IP
Gas Piping
1-5 Outlets
5+ Outlets
Gas Fired Heating System
1-100,000BTU
Obn13-1 ij
10u,,;00+ BTU
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 a com-
plied with whether specified herein or not. The granting of a permit does not presume to give autriority to
violate or cancel the provisions of any state of local laws regulating construction or the perform nce of
construction.
SIGNATURE OF^ �, A/ APPLICATION
OWNER OR tea/ C-Gctlo DATE