1986, 03-25 Permit App: 00010223 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 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-‘• /%/7 (,i/% , APPLICATION
OWNER—OR �9-/%/i:���i DATE �`�06,
Project# }02,Z5 /
f t/
Owner's Name Last First /'-/�J MI
c�/.f1/ T/-/ SC //LL
Project Address (Street Name & Number
C . a00 A/Cl-
Cit
State
Subdivision/Plat Name
Assessors Parcel #
Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor -
/.o% 7-�—.j..1 c`X�-- ,�. A/CC
Address
. y�cso C -7-1-2.2,:s.. • J
CIt 4,, Q
7.‘,./_ve-e _
State
Gt."'
Zip
99e.2& 1
Phone
saw - 73 s3
Conte t
>l,� i
License #
lq-C9c, A /4 406- c6
Business Phone
9 i
Describe ork
ai
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Wate Htr
Solid Fuel/ Wood Stove
Air Handling Unita
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 _ 2
1-5 Outlets
/
/ >
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10u,:,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-‘• /%/7 (,i/% , APPLICATION
OWNER—OR �9-/%/i:���i DATE �`�06,