1986, 01-07 Permit App: 00009330 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--
OWNER OR
APPLICATION
DATE /7‘
Project # /.� J 3 2 40
_ (
Owner's Name Last :It t MI
�f5 h, ' S 7i,61.01
Project Address (Street Name & Number)��
• 3 7 /,/',-1
City _
Ci,z
2
State �!�
`_
Subdi IsionlPlat N e
Assors Parcel #
Lot
Block
Plat #
Applicant ,�`
, ' lit://h
Address /�
3 7 2 -7 Gam, -,/a010
City
�a9s4,C-- 1
State
k(
Zip
q ? 2� -
Phone
114,9 —14`x.5
Business Phone
Contractor„..,
/�P,' iii
Address
3 7 2 coe,e/eT�
City
�/j,t�,i'/A-^
State
W/9.'
Zip �j
-77.2a9
, /
Phone
f 4/ / e a�7
�
tact
License #
/I/ '7 1 if/ —6/r
/P/I/7-
ne
Business Phone
5.�pli'
Describe Work `
7 L/ a(% %
71
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
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+ HP
Gas Piping
1-5 Outlets
j
6+ Outlets
Gas Fired Heating System
1-100,000BTU // —
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 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 /7‘