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1986, 11-24 Permit App: 00014444 Furance0 o MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND I4 -0501 - ©1,2Z- 45 135 X/O'L. I 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 ot, % APPLICATION fpv1 �� DATE 1 1/0 / Project # /11/0/ �i Owner's Name_ Last First MI / //`tie ov Iv( 67 /UI4/i'S0 i/ Project Address (Street Name & Number) //0 0 9 /III A -/lo i% City S (9d kik // 8 StateSubdiv 4— /Plat Name #uG-14A41 Assessors Parcel #, J /G L/ Lot / 3 Block -16 / Plat # Applicant Address City State Zip Phone Business Phone Contractor / if CO 4/y& ddrese 06/rriCityS "L� �4-- Stat c/ re Phone - a 3C Conact M' License # dRdieh / /v ''2-Bus�i/nees Ph� (`1 "e oO e Des N rk _ L _2.e / S -��� Cil �y �,' p . Fans Evaporative Cool Hoods Electric Furnace/ Ducts Miscellaneous Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove Alr Handling Units 0-10,000CFM 10,000+ CFM Refrigeration Systems/ Heat Pumps (BTU) 1-100M i 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 / 10,0;00+ BTU 2•.- I 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 ot, % APPLICATION fpv1 �� DATE