1986, 11-17 Permit App: 00014224 Furnace, Piping 110
MECHANICAL PERMIT APPLICATION WORKSHEET %
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# 4(L,/
Owner's Name Last First Ml•
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Project Address(Street Name&Number)
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City State Su ion/Plat Name
Assessors Parcel# y Lot Block [Plat#
3
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Applicant Address
City State Zip Phone
Business Phone
Contractor Address
City State Zip Phone
Contact License# Business Phone
Describe Work
Fans Evaporative Cooler Hoods Electric Furnace/Ducts M scellaneous
Dryer Range Gas Log Gas Water Hfr. Solid Fuel/Wood Stove
0-10,000CFM 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 3-15H P 15-30H P 30-50H P 50+HP
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10.,L00 00+BTU
Gas Fired Heating System i
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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 OF7F! APPLICATION
OWNER Obi .DATE
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