1986, 07-10 Permit App: 00012090 Furnace MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLYs'I,HgSE PARTS OF THE FORM YOU,UNDERSTAND
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Last First,,. MI
Owner's Name _
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Project Address(Street Name d+Number)'' `,"
/u�71 4. 7V(./74-2 L,E --7-2-
City State Subdivl I I at Name �
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4,10R
LotBlock Plat I
Assessors Parcel I /5V-2 - i(O8
6 J r,� '' Address
Applicant
-50•/17
Phone
State aD 9' (�
City I %�j,e/4 '—'.12 + 0
f, .;. Business Phone
Contractor Address
62;4/t7/0/ ` , �4 Z.... [77- .. /yen rglX "67Y
city , State Zip' 4720?-2-.- 5.3_3 /7 /
c �',�f�/t/ 7Business Phone
Contact
License I �)
41//A/ --.);-(4',/4';'17' gg,'rw; V " '"f=3 75'4'7'
Describe Work „�
%Ii/r�l�}�� i. /z- 1-f a/i/i-
Fang
Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Range Gas Log' Gas Water Htr, Solid Fuel/Wood Stove
Dryer
0-10,000 CFM 10,000+CFM
Air Handling Units
1-100M 101-500M 1501 -1,000M1
Refrlgeratlon Systema/
Heat Pumps(BTU)
1,001.1750M Over 1750M
0-3H P I 3-15HP 15-30HP 30-50H P 50+HP
Compressor I
IT e+Outlets
Ou.iets
Gas Piping ,
d/L 1-100,000BTU 16,,,00-+/BTU �/ �j 3 t/I/
Frits Fired Heating System �'"`'L r� /
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i
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 .y� �� APPLICATION v�/ ` _�
OWNER OR
/C/�� y ��/� DATE