1986, 10-03 Permit Ap: 00013406 Furnace C,
/,�
1 /,
MECHANICAL PERMIT APPLICATION WORKSHEET
/'1 PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
'‘... Ij
Proect#
Owner's Name Last yirst MI
7f13114 17 , 4,L. 7
Project Address(StreeName&Number)
/ V c ,a.7 \1/7/1/ 1 gA2(/ Z-7-/L2
City / / State Subdivision/Plat Name
Assessors Parcel# Lot Block Plat#
Applicant Address
City State Zip Phone
Business Phone
Contractor � / -.
ir 4 A__./77 Ad 4:, s_.,,,, ,... ,/ 77-e,/t77._76,/ r
City "/ /// /tj)-.� State Gil /((-— Zip /` Phone 32-/—
L/ 4 7"—
Contact '""/1 License# `rl , usiness Phone
0 /i'7 y4 'Xr,4 / 7/) /fz , ,
Describe Work
/j
Fans Evaporative Cooler ___Hoods 7 Electric Furnace/Duct Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000 CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
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 10,,,300+BTU
\-----\,_::-,7'6-1--t-er(.„-c ,L:6:e__,- 7- ,e,-,,e1-74 ,,elc'q:_e_c______,„
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 /ç/ /ft
OWNER OR l" � - v- V c `-7 DATE