1990, 01-03 Permit App: 90000029 Furnace, PipingMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
As
f5
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 corn -
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
OWNER OR
APPLICATION
DATE
Project N
Owner's Name Last First MI
c9 v s -,e-- /17 / i' a e -----if'
Project Address (Street Name & Number)
City,.
State Lam,
Subdivision/ Vile
Aukl )k) 4CieEs
re ParcelM5
13 — 04-40
Lot
Block
Plat ft
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor - ,
62 & GG. /e--/e--4,15z/ �,oi b % ,,C_ t'
Addressr
`` T'� %LO �-. - /4,--;-
CityState
ie--4�_ ��9
Zip
994/�
Phone
ff3s-a��9
Contact
License#
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water 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
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System 'r �j ee
1-100'000BTU
10v,L00+BTU
GAJ
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 corn -
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
OWNER OR
APPLICATION
DATE