1987, 04-20 Permit App: 87001049 Furnace, Piping /sad r
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117°-0 MECHANICAL PERMIT APPLICATION WORKSHEET
- PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# 87 /Q.�
Owner's Name Last First MI � �
/444 L 6 E 07— rg1Y3 i
Project Address(Street Name&Number)
E is a.os 41-..
City State Subdivision/Plat Name
3lawc(44,...e6 tal
Assessors Parcel# Lot Block Plat#
Applicant Address
/ttW eV }I-te*77n1i t gvje t!ewzj irzn)/4,17 ! Co TJe e41-7--
City
41-City State Zip Phone
3,10,D - 144 qIZi Z 5 "7' Y`i73--
Business Phone
Contractor j Address
IVO)?C C.) /412.14-4-761 ) d/ 112- Ce/kJrii 71.-4.1pc4Z t 5b 1 t.'
City State Zip Phone
5/4o K Gc.4 °I(z-1 Z 5-3 v 47 --
Cont ct License# Business Phone
7 erh -- "Re fr1 P007ee0bI4I-70 7--
Describe Work
„Tit,s (r4-- F - -- cv'74 /7't 4,47,4
Fans Evaporative Cooler Hoods Electric Furnace "MEW 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 15-30H P 30-50H P 50+HP
CSOutle _ 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU �/� 10v,�00+BTU
k,io F E C'U 0 c Oo7 k- it.,c c LE-L; c_</o►7 r(1 r—`c C PJ.cT
,U/SI-4-C( 1"=Z. 1:;-4 S i 2/!JC- SZ PER CSI IT C.CT
Or.f o— 4-A.ii' RLCy.rA
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 OFAPPLICATION z�—�7
OWNER OR .DATE r~