1988, 08-07 Permit App: 88002353 Furnace, Piping -
MECHANICAL PEiMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project#
Owner's Name _. Last irs MI
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Project Address(Street Name&Number) .i ,
City State I �� Subdivisio at Na.., ,f ,
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Applicant L- Address__ L A
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City , St to Zip e �]
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Business Phoneme
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Contractor _ Address
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City c.,.,_
"_ State 4Zip Phone
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Conta License# Business Phone
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rite Work t
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r _ �_i�.�=.. 't c-- G9`, lid Q�'ic.E'- � �, _ CI.. L' � Va..0 �..
Fans V Evaporative Cooler Hoo Electric Furna a/Ducts Miscel s
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
Compressor 0-3HP 3-15HP 15-3OHP 30-5OHP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU 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. f\
SIGNATURE OF n
t-x=C- -- APPLICATION .
OWNER OR ` .DATE - Z` r,.