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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- ""