1987, 10-27 Permit App: 87003727 Furnace MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
srioa se
Project#
Owner's Name Last First MI
Fi e ther-. sA/h i.---
Project Address(Street Name&Number) �j /
oa-/ A ' ./� / littiUeCSi
City / State Subdiv it NameOr.. 14"4yb
1 45
Asse ors Parcel# 2!Elk—
/ig`/ Lot "7 Blockbili Plat#
Applicant 1[� rLw1 Address
4vie�1`ca.n ti4- P/h4' Cenl1;e .___ u.). 111) 4 aanld, nj..
City State Zip Phone
X7,0/41 AG ih 990 o s— 3.0 7-S- S l o
Business Phone
1/1,1 1 Address
Cont actor /
liner kc+A e.- ,47 se/Ic/1 -c, 40. //aL Gs/41
City State Zip Phone
�j- pnAn e.- Idd q 9 4 os""- 3 .0 7_S5/c
Cont License# Business Phone
AM,. ///P 4a/ ,' 7 7S3/a
Describe Work
cp hie. erxis/:n i l ds
Fans Evaporative Cooler Hoods! Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000 CFM 10,000+CFM
Air Handling Units rf ,.
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
0-3H P 3-15HP 15-30H P 30-50H P 50+HP
Compressor
1-5 Outlets 6+Outlets
Gas Piping ,
ekt
1-100,000BTU 10v,;00+BTU
Gas Fired Heating System141 000
idc. r e m D dei 44 49/o/ oc/S /2'i'adze_ el 0 d
1 d Sial d aced ?dS larld!e..
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 �— —�' —.DATE 1 0- a ti-6 Z