1986, 01-29 Permit App: 00009702 Furnace 11
�' - MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project#
Owner's NameLaa , First MI
Gee lt�,-7 zv
Project Address(Street Name&Number)
. ,co Yi . J& -/L '
City i State Ivision/Plat Name
Assessors/Parcel�P9e) ! A-2� G(.)(,/ Lot Block Plat#
t .5.-72 - L, 6 .1 C P7giiot J
Applicant Address
( te ) OVA l/3/ r -(,—,
City State <
/ Zip? , Phone / -�
..r_ 4_,/e./!(.Y _ 7(_) '—.. % . (�S' 64 —A-24'
'9
/// Business Phone`
Contractor Address i' 2
JCity State Zip Phone
. GO, rrZZO (W�—l /7
Le ,
Contact
� License# Business Phone
� 7_.'®'C942//(aL7 42,- -ar--, f' -3/),J) ___ ____
Describe Work --�
, r'1- "4,1 .,.) /.-(_1LCL-Q ..
-'�.
Fans Evaporative Cooler Hoods G(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/ 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_..--) /1‘jgp 1°',L00+BTU
(212:
2 -
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
vrsions 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 / J APPLICATION
OWNER OR _-)t� '"l 2 - l_.- rkhcii/lc.<' L DATE 0 9••.'