1985, 06-06 Permit App: 00006016 Furnace • t )
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Owner's Name I Project# /�
Last MI
c First 4
im i C ...e..Ct JU
Project Address(Street Name&Number)
City I State
Subdivision/Plat Name
Assessors Parcel#
Lot
5075 I Block I Plat#
Applicant
r Address
City I State
L Zip Phone
Business Phone
Contractor
_, L )4-r`- '-'(- -4''
4-� j
Address
City State I E to), NUR A
Zip Phone
1./UCL. 9 ,,,)c,-.-? 3? 5.-- Uy3 /
Contact License#
' Business Phone
Describe Work
Fans Evaporative Cooler G' Hoods _
Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log
Gas Water Htr. Solid Fuel/Wood Stove
Air Handling Units I 0-10,000 CFM 110,000+CFM
Refrigeration Systems/ 1-100M 101-5
Heat Pumps(BTU) 00M 1501-1,000M
1,001-1750M Over 1750M
Compressor I0-3HP 3-15HP I15-30HP
30-50HP I50+HP
Gas Piping 1-5 Outlets
6+Outlets
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.
SIGNATURE OF APPLICATION
OWNER OR f3,'k ..- ----,-:-I-L.. DATE i_ - 6 - a- ""