1987, 10-10 Permit App: 87003701 Furnace, Water HeaterMECHANICAL PERMIT APPLICATION WORKSIIIIEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
iso
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.
F
SIGNATURE O
OWNER OR '
APPLICATION/,
DATE
Project # 370/
Owner's Name !test stMI
Project Ad r s (Street Name & Nu r)
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City
State
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Subdl Isco (Plat Name
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Assessors Parce tf le7 , `/� /
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Plat
Applicant , .L�q 11��-t-\.�
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Zip fQ`C-r3
Phone�U3CS HJr7t
Business Phone
Contractor
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Address
City State
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Zip
Phone
Contact 7—
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License #
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Business Phone
t83a- 9Sa3
Describe Work
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1"K 4\a-cem V Br5 5 it .-4a lctc-e -\- -LA icslc e
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Fans
Evaporative Cooler v Hoods t
Electric Furnace/Ducts
Miscellaneous
Dryer
Range Gas Log
Gas Wate 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
1530HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTi
10..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.
F
SIGNATURE O
OWNER OR '
APPLICATION/,
DATE