1986, 11-03 Permit App: 00014244 Furnace, Heat Pump -,
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project* 14% ' L,;-1-
Owner's
j
Owner's Namee:Last ; rir MI
t � >L y �
Project Address(Street Name&Number)
L 1(r." e)7 G' ' t
Cit)Sit Subdivision/Plat Name
- 'ketAnz tk CI":0.1i.
Assesso/ Parcel# Lot Block Plat#
Applicant Address
City State Zip Phone
Business Phone
tractor ^ 41 //4261 Address
4(1-1
6,..::- /1:2 —V() .i.,Q1/Cd-t.i.,
Cid. ,,,.....1„4"yuz_ Mate j / Zips„ Phon
Cont A }� ( / Business Phone
`//' J
., ,License et/ u A f�C ! l 3/V l €
Describe Work( t t e
_
-tit .� lt- e 1JC1':11( ;7,--4-e-I ii koelff-A' “,/,
Fans Evaporative Cooler Hoods c Elq.ctric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-- M 101-500M 501-1,000M
Heat Pumps(BTU) �!/ i. , /(.57 Q�yl _ ,e i_A.
I
1,001-1750M1 -175t�1W`�^ Over 1750M
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System
1-100,000BTU 10v,,:.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 OFA 7i42/(A'611 )
APPLICATION ii 7 (i/,
OWNER OR ( '' .DATE