1986, 11-13 Permit App: 00014254 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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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 OF7
APPLICATION
OWNER OR (_��� DATE r 1 IL
Project #
Owner's Name
Last
^_/7
Firs_ t
MI
Project Address (Street Name & Number)
Vt.R' 4
City �
State � �
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Subdivision/ PIat�J 1 � �S
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AssesV Par7 #
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Lot
Block
Plat If
Applicant
Address
City
State
Zip
Phone
Business Phone
tractor
-
Address_ �])
0 � C / !f
C
S e
Zi
Phone
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Con
Lice #
M
uAt{E
I93 Il
Business Phone
Describe Work
046"tdk
44utf—
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Flange
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Unita
0-10,000CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M 7_07--110-10M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15 30HP
30-50HP
50+HP
Gas Piping
1-50utlets
6+ Outlets
Gas Fired Heating System 'r `
WJ
1-1001000BTU
�Dv
10v,LW+BTU
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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 OF7
APPLICATION
OWNER OR (_��� DATE r 1 IL