HomeMy WebLinkAbout1986, 01-07 Permit App: 00009342 Furnace1544- - 22-18
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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 .��i
OWNER OR
APPLICATION /✓��
DATE
Project #
MI
Owner's Name t VA./14,01.--i
Project Address (Street Name & Number)
E 103 nt3
C
City /
State
tel
Subdivision/ Plat Name O f 1 om ( f
p
TY
Ass /Parcel #..._
e�51-2-425
..,
Lot
Block
Plat #
Applicant
Address
City
State
Zipn q O
7
Phone
Business Phone
Con
actor
(,) dadll
Address
' IA 7/6 •:9t.f.itez.44.4:._
CI /
•d . I ' I
Sta
.
ZiTg / �
Phone?,T /�
O`./OL/
Business Phone
Con f ! j License #
' u ..- Atte /93N1
Describe WorkIIr ° )111,e) Oftvat I 4 000 iV
Fans V
Evaporative ••
er
Hoods
Electric Furnace/Ducts`/lMiscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+ HP
Gas Piping
1-5 Outlets
6 + Outlets
Gas Fired Heating System
/ti �
1-100TU ar/tts• ®
1Q+,w�+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 .��i
OWNER OR
APPLICATION /✓��
DATE