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1987, 05-01 Permit App: 87001205 Furnace, Range
MECHANICAL PERMIT APPLICATION WORKShIEET 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. SIGNAT © APPLICATION...) ' A Z OWNER OR - DATE Protect # MI Owner's NameIR 0 . Last S First Y� 1:0 A Project Address (Street Name & Number t 11 > \I ‘;') --c..S9 City State Subdivisio /Plat Name Assessors parcel Lot Block Plat # Applicant� bk4 i' % -Nil 1 -"k Q -0:t tom? Address /'� 1 U9 37-Tk A\-42-.) City State t ip C(1/90.3 Phone • F53S5— 115a3 Business Phone 1,,] _ S 3 1593 Contractor, ` G Address City ' "� State ` C—Xw J\ Zip gq 3 Phone 38 - 57d3 Contact Utz G . License # a C)7Lp - - Business Phone g 51r- sa- Describe Wgr.t• ^� 1"k �,14:A S.11 c' \VA14. W ccr..--s--k-*- tN�k-3.1/4\ C.V�V. c 3\itVNJ9 N"ciA �Fans Elaporative Co Hoods Electric Furnace/ Ducts Miscellanea s Dryer Range Gas Log Gas Water 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 15-30HP 30-50HP 50+HP Gas Piping 1-5 Outlets 6+ Outlets Gas Fired Heating System 1-100,000BTU 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. SIGNAT © APPLICATION...) ' A Z OWNER OR - DATE