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1987, 08-26 Permit App: 87002769 Furnace, PipingMECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND c r eo 215 /3i ' 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 V __ i` 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 / / C C 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 __