1987, 05-01 Permit App: 87001192 Furnace/Heat Pump MECHANICAL PERMIT APPLICATION WORKSHEET
'- PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project#
Owner's Namekt Fir MI L 1
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Project Address(Stag Name�Number)
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Cit State . Subdivision/Plat Name
r e.e<U,4n-reS �, IA . 7 o 1
Assessors Parcel# Lot Block Plat#
AppAppIgne& Address
V
City State Zip Phone
9 6—&57g
Business Phone
Contrackor Address
�- 1CAp;
• (,27/6 Ji.4-.6424.1.4 .
City Phone
4 , - SVJ4 Z( ( , ( / lU ,a
1 es/
Contac/ ,o. License# Busf Phone
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Describe rkcvDcet4.1 �1 1
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000 CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100M1117500M 501-1,000M
Heat Pumps(BTU) /-C V,n 01O let rq
1,001-1750M 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 10u0;00+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
construction.
SIGNATURE OF17/ APPLICATION 0j/e7
OWNER OR DATE