1986, 12-05 Permit App: 00014429 Furnace, PipingMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT 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
APPLICATION
DATE
Project# /4(121
Owner's Name pt / First MI
Project Address (Street Name & Number)
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J
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City
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StateSubdivision/Plat
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Name
sr Acrt.S
Parcel #
Ammo6
G et54Z -
0'120
Lot Block
Plat #
Applicant+
41) GS / '" /,
Address
F /o," i 6/6q -c e
City sc
State
Zip / 4.70 �7
Phone 5, 6 75D
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work / p + .
Alec.) ‘,..1.s.+ 16,. r,Vw}c e cif- eiei At
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Unita
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 `/
5+ Outlets
Gas Fired Heating System
1-100,000BTU ....„."--
104,,:00+BTU
21c0
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
DATE