1985, 11-15 Permit App: 00008642 FuranceMECHANICAL 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 0
OWNER OR
APPLICATION
DATE l//7 /1,5"
Project # 0692,
Owner's Name First MI
/
CJEzeS�!/HS7—
Project Address (Street Name & Number)
City
State
L/(/
Subdivision/ Plat Name
As�7#/,
rs Parcel #
Lot
Block
Plat #
Applicant //,e %/� f�/%�
!' ' 44>9
7
Address /'-
3 27 G�.�U�/-
City
07. i7"IA'
te
1,,e4, -',fa®?
Zip
Phone
'7y /4/4 '�
�U
Business Phone
Contractor �L'
/PY- //%
l N�
Address {�
/./1 i'l7/'�
City 1Sttate
Zip
—
Phone
t
License
iey16i¢ — /67C,
Business Phone
Tr9,,,,K-
Describe Work
7��/
Fans
Evaporative Cooler
16
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000CFM
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
6+ Outlets
Gas Fired Heating System
1-100,000BTU
104,0;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 0
OWNER OR
APPLICATION
DATE l//7 /1,5"