1985, 09-23 Permit App: 00007667 FurnaceMECHANICAL 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 - - /APPLICATION -
DATE
OWNER OR it �� ^�-�.��
Project #
Owner's Name
Last First
MI
Project Address (Street Name & Number)
City
State
Subdivision/ Plat Name
Assessors Parcel# (_
Lot
Block
Plat #
Applicant
Address
`.
City
State Zip
Phone
Business Phone
Contractor
Address
r
Cit
State Zip
Phone
Contact
License #
Business Phone
o ' Y ..
SCF
f
i�
J
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
0-10,000 CFM
10,000+ CFM
Air Handling Units
Refrigeration Systems/
1-100M
101-500M
501-1,000M
Heat Pumps (BTU)
1,001-1750M
Over 1750M
1530HP
30-50HP
50+HP
Compressor
7-3-15HP
1-5 Outlets
6+ Outlets
Gas Piping
1-100,000BTU
10.,;A0+BTU
Gas Fired Heating System
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 - - /APPLICATION -
DATE
OWNER OR it �� ^�-�.��