1985, 09-16 Permit App: 00007849 Furnace MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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I Project# 7e
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Owner's Name Last, First MI
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Project Address(Street Name&Number) JlJ1
City State Subdivision/Plat Name
STeU1C,tC / Op ate, 6.
Assessors ParceljLLot Blc Plat#
Applicant Address
City // ( tate Zip Phone
Business Phone
Contractor Address
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City State Zip Phone
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�/1,�c i��,L_ -191 ,)0 67 f/ X�' S7�.,
Contact 1
g - License# Business Phone
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1L5Y .. CL .y�"; oto, -et i 5 r - 'S Pik)",Describe Work EJ bJ
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
Air Handling Units 0-10,000CFM 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� 10,,,,;00+BTU
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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 c/7,
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OWNER OR Lt. .) k e `zf �a_e_ .DATE � /4.;/K�