1986, 01-09 Permit App: 00009448 FurnaceMECHANICAL 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.
DATE
SIGNATURE ��s2 APPLICATION ///j7
Protect # "
W3
Owner's Name Last First // / MI
12117-1-/ 7`7Iin 5
Protect Address (Street Name & Number)
�• fee /%.o4. 4SstQ
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State (((
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Subdivision/Plat Name
Assessors Parcel #
Lot
Block
Plat #
Applicant
Address
City
1
State
Zip
Phone
Business Phone
rector
.d !�!' , ( /
ed Address
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7oC E .0Cit
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St t� /
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Zip
9�' a
Phone
6:65- - 73-$ -
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License #
5/)1//9 _ 14 440& &D2
Business Phone
ibe Work
. ../_s.Dt'
p l�Dt-.,lsdsie (p
Fans
Evaporative Cooler
Hoods
Electric Furnace/C WA 9 j
L -.cmc— . (P_
,. S
MMiscelllan -71,01.-'&4'4,.
`'!�g011J
Dryer
_
Range
Gas Log
Gas Water Htr.
Sol id Fuel /Wood Sffive
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
30-5OHP
50+ HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000137U
10v,,,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.
DATE
SIGNATURE ��s2 APPLICATION ///j7