HomeMy WebLinkAbout1986, 10-07 Permit App: 00013606 Boilerc2 p�IyIM,.yt ?
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-0 MECHANICAL PERMIT APPLICATION WORKSHEET
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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 71
/7/N
DATE
Project #
Owner's Name Last First,MI
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Project Address (Street Name & Number
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City
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State
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Subdi' ion/Plat Name
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Assessors Parcel p
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Lot
Block i
Plat r �O
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Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
Address
City
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State
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Zip
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Phone
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Cont t
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Licensee
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Business Phone
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75 ---'Describe
Describe Work
o#s
Fans
t,,
Evaporative Cooler ds
Electric Furnace/Ducts
MiscellaneousDryer
Range 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
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping f 3
1-5 Outlets
6+ Outlets
Gas Fired Heating System ✓
1-100,000BTU
10.,0;00 + B7U
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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 71
/7/N
DATE