1986, 04-23 Permit App: 00010675 Furnace21
MECHANICAL PERMIT APPLICATION WORK$H UT
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
Project # i/ nwk.-Ls.Owner's
Name Last / First MI
(Of? jrlig'Gre7 C>f<%//
Project Address (Street Name & Number) , fN. 5 O ,/,��94'
City
State
Subdivision/Plat Name
r
orb Parcel #
Lot
Block
Plat #
/,-, %�,�
Applicant `%//A Si/Y/44/97,-;r7
fi/ ` (' - E' • �/ r /r1
Addresses, ^� / J
/r 7 2 ' Cevri0 7/e/s#j/s,
City State
r" e'4/.-,,= /9 .
Zip
Vtlf 26,-?
Phone
4/x"`9 --/ et. L7'—
/
Business Phone
Contractor
9 V914 7'
Address
City
State
Zip
Phone
Contact
_�d1/ _
License#
%� '/ii/�6/s' /67 CK
Business Phone
Describe Work /- ,.,C
`fes t//it %/ t- effil_ (Ai Di- 4,4-t e 1 let,liPp-'/(
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
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 OF
OWNER OR
APPLICATION
DATE