1986, 01-27 Permit App: 00009502 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
00
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$E
AWtdEW
APPLICATION
DATE /022/S7
Project N
Owner's Name Last First MI
•S --C ,9 »iA t'7 Z _e 1-1.4%
Project Address (Street Name & Number)
N fTev P .4 ✓A t LJ \DK
Cl...—,
'21e°0iiie]ifi 6..
State
k2
Subdivision/Plat Name
Assessors Parcel #
Lot
Block
Plat N
Applicant
Address
City
State
Zip
Phone
Business Phone
tractor
Address
1.City
State
Zip
Phone
Contact/ �"7
�> i�/_.,47..J
License #
fie 2,'I 4— 14 506 -2 a _
Business Phone
2. -
Describe Work
Fans
Evaporative Cooler
Hoods
-Gas
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Log
Gas Water Htr.
Solid Fuel /Wood Stove
Air Handling Units
0-10,000CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping /r 2
1-5 Outlets
/
6+ Outlets
Gas Fired Heating System
1-100,000BTU x.
10+,;,00+BTU
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE$E
AWtdEW
APPLICATION
DATE /022/S7