1987, 08-26 Permit App: 87002769 Furnace, PipingMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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215 /3i
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Project p tile 4/]
Owner's P:arne. „^Last First ^Iw�MI
'^
1 C�r` a1_ \
Project Address (Street Name & Number)
�'rl IS.- lf. 4
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CII • Stato
1
Subdiv skin Plat Name
M /Rov Es7 /Jo S
Assessors Parcel pO! / n _ iq/
Lot is
Block
Plat p
A•pecant'
Address
r.
State
j
,.�__
Zip
Phone
,Gymei \
.
Business Phone
Contractor
Address
City
State
Zip
Phone
Prat
_7 11112.51_
License p
K S P ' cs 3
Business Phone
14
Describe Work 1
1
Fans
Evaporative Cooler
Hoods ✓
EI lc Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Wet° 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
.,.I
Over 1750M
Compressor I
0-3HP
3-15HP
15-30HP
30-5OHP
.. _. ..,.
SO+HP
Gas Piping ,
1-5 Outlets
`7 -/b0
'J `�—
6+ Outlets
-
Gas Fired Heating System
1-100,000BTU
1P,,;,OO+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
r .nstruction.
SIGNATURE OF
OWNER OR
APPLICATION
DATE __