1986, 09-19 Permit App: 00013276 Furnace MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY1-1 SE< AF TS O�F+, THE,r,ORM YOU„UNDERSTAND
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Project r /3. 7L!/
Owner's Name Last First MI
64$);. ,,D /fel/
Project Address(Street Name&Num )
City State 8ubdlvlslon/Plat Name
j,� �-- ,fit ,
Assessors Parcel If Lot Block Plat 0
^�Applicant Address
City State Zip _ ./� Phone G �/ 7
/G/ Business Phone
Address , //}/
Contractor r ;4'/f/✓� /�.� C� /e ,4., /�' V3//‘
City J� State6 Zip-. Phone
Con tack,y._- License 0 Business Phone
Describe Wore T f / 6 � � �
Fans /vEA`evaporativeCooler Hoods Electric Furnace/Ducts Mlsailaneous
Dryer Range sae Lop?,' Gas Water Htr. Solid Fw1lWood 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 Ow 1750M
0.3HP
3-15HP 15-30HP 30-50HP 50+HP
Compressor
1-5 Outlets 5+Outlets
Gas Piping
1-100,0006TU 10u,J00+BTU
Cs Fred Heating System A.1.46:4,/,/,p& �� 7�” �G�
1
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 9,–// —Z ,
OWNER OR 714 '/' DATE