Loading...
1985, 02-27 Permit App: 00004375 Furnace, Water HeaterMECHANICAL 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 colt 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 a 7 5, OWNER OR �� DATE Pre4e,1 # , 3.-7 5 Owner's Name Last First MI Al c CIA ATI4 Y►1► g_p- Project Address (Street Name & Number) 5. 3 (. 0 Ci Lc) Q.-e,T'T 4 _ City State Subdivision/ Plat Name Assessors Parcel # Lot Block Plat # Applicant Address City State Zip Phone Business Phone Contractor 3 WN ,T14 N-ex,,A..;.,,s,, Address E - ion ivc)(RA City 5p State w A Zip 9,..2o 7 Phone Contact License # /J •2 c - Sn/S Business Phone 30 8—yy3 Describe Work Fans Evaporative Cooler S Hoods Electric Furnace/ Ducts Miscellaneous Dryer Range Gas Log Gas 1N'r Htr �t/010,000+ Solid Fuel /Wood Stove Air Handling Units 0-10,000 CFM 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 1-5Outlets 6+ Outlets Gas Fired Heating System 1-100,000BTU iv ,�0 c(? • �i 10v0;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 colt 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 a 7 5, OWNER OR �� DATE