1988, 10-18 Permit App: 88003361 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FOR UNDERSTAND
1 Project #
Owner's Name Last ` First MI
Project Address (Street Name & Number)
Oe; ns
City
State
Subdivision/Plat Name
Assessors Parcel #Lot
)7s4 2--5-_.0
Block
Plat #
Applicant �. /
/,}r' , 1J� 4il./1'7 f Dos
Address (� �}
g Ze /Lfi1�i°7 6:3 l/i%� .7.. -
City
City
.w1 -ec
e
C a-
Zip
—
9///4L
, 6-t36 = 9 a 7
Business Phone
Contractor
1,6�,+,f, ate,' i6.4, - g—
Address
Li/ .--'e-4i Gla ..-
F./J1
City v
.f, -4,J.-
State
It) 0,--
Zip
99a1//-/ 4/G ?
Phone
..s as-9"44a.y
Dont
License #
0, ,) /4/7f
Business Phone
`�5cA. —_4C.7
Describe W(tsk�
Fans
Evapor eCooler
H
we ricFurnace/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
1530HP
30-50HP
50+ HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
f/
10x,:,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 /0-t (-477