1987, 09-18 Permit App: 87003163 FuranceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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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
ruction.
SIGNATURE OF
OWNER
/
APPLICAPON q/dr?
nAtr
Prolect
Owners Narne Last First MI
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Proiect Address (Street Name & Number)
Cit
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State State
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Subdi son Plat Nea)
(12±121.45pr
Asses Parcel 0
Lot
Block 6Plat
#
App icant
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Address
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City
State
Zip
Phone
Business
Phone
Contractor
Address
City
State
Zip
Phone
ntact
... ..
License #
e.....4- _
14,, . all
Business
Phone
Describe
0
......"...4........................
,...a....::......a..ww:
Fans
vaperative Cooler ;it
Hood
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water
Htr.
Solid Fuel/Wood Stove
Ai- Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (LTU)
1-100M
1,001-1750M
101-500M
Over 1750M
, ,.
601-1,000M
. . ..
Compressor
0-3HP
3- 5HP
15-30HP
0-50H P
50 + HP
1-5 Outlets
6 . Outlets
Gas Piping .
alliiiiGnk
Gas Fired Heating System
1-100,000BTU
q •=5.....
10v,L00+ BTU
1 s--7-4--3
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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
ruction.
SIGNATURE OF
OWNER
/
APPLICAPON q/dr?
nAtr