1986, 02-13 Permit App: 00009687 Gas Furnace0
MECHANICAL PERMIT APPLICATION WORKSHEET 1-7
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
`h Iyugl V -J
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 If-
i,�
O Name
Last st
MI
Project Address (Street Name & Number
S
Cites -> 7 j
State
CAJ
Subdivision/ Plat Name
Ass ssors Parcel#
Lot
Block
Plat #
Applicant
Address idc�
City
,•li
State Zip
c�,�i
Phone
G �Go
Business Phone
I. t
on r r
Ci
'
Address
IV®/ I
State 64.)Zip �t Phone
Co act
k4Msej
`,1/]
{
Business Phone t'
Describe Work
4.r"4<.
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
'7
Over 1750M
Compressor
0-3H P
3-15H P
15-30H P
30-50H P
50 + H P
Gas Piping
1-5 Outlets *171 .�..
6+ Outlets
Gas Fired Heating System
1-100,000BTU(
C,
10., 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 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