1986, 10-30 Permit App: 00014044 Furnace � 9
MECHANICAL PERMIT APPLICATION WORKSHEET
;‘ PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
I Project# Wzi/4/ 1
Owner's Name Last First MI
/4_4
Project Address(Street Name&Number)
o.--R(0.-- /4 - ç2(247(9( le l7
City State el, Subdivi onl Plat Name
Assessors Parcel# ` Lotp. Block Plat#
2--15 ,�2 28o9 __ 2 r c
Applicant Address
City State Zip Phone
Business Phone
Contractor Ad. = s
3
City Sta Zip Phone
7--
Contact License# Business Phone
Describe Work
e'er
Fans Evaporative Cool Hoods Electric urnace/Ducts M scellaneous
Dryer Range Gas Log Gas Water Htr. So id 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 15-30HP 30-50HP 50+1-4P
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU >"' 10,,,,;00+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 0F�� ee /()Lat y APPLICATION (c
p
OWNER OR .DATE