1985, 09-23 Permit App: 00007665 Furnace rA ..
• ' MECHANICAL PERMIT APPLICATION WORK$HUT
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# .7665
Owner's Name Last First MI
Project Address(Street Name&Number)
City State Subdivision/Plat Name
Assessors Parcel# ! Lot Block Plat#
ApplicantAddress
SI"14 ( 7.---/ iNe /9 e < / 7.,..2_7 7 g i ,,,,P-:,,,' A1-7,2,-4 0
City State Zip Phone
Business Phone
Contractor Address/
)t, %L r,41/-2/ Ai- > v..„-, (� /� , ,- 7-4
Cc.%
State Zip Phone
-�:7�.�?.7C-a 1--L -e (v /.' z/ [ '. — n
Contact License# Business Phone
utiJ - 04ed-1 ' w//'
Describe Work
Fans Evaporative Cooler Hoods Electric 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/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
0-3H P 3-15HP 15-30HP 30-50HP 50+HP
Compressor
1-5 Outlets 6+Outlets p1 Com'
Gas Piping t-
Gas Fired Heating System 1-100,000BTU / 10.,:00+BTU
i
711,--_5 7-41// ,-CdC" L , / 7-- ''', /7.-'" 4 c 6-- cv ole., 7.--- ,4,,<--
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 OF - APPLICATIO ��
OWNER OR '------'e7 e.--'` - Iiv .DATE 7=%' �S s-