1988, 10-14 Permit App: 88003281 Furnace MECHANICAL PERMIT APPLICATION WORKSHEET
0 S t,, . RTS O TH ORM YOU„UNDERSTAND
PLEASE PRINT.AND COMPLETE ONL4•Y,� 1.1141,:'•
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Project
Owner's Name Last
First...
sLy , RG
PrOlect Address(Street Name&NVmtfK),' 0 t 0 (:..2 . ..
�, l-/ t'' ^LC y
City Stats Su Ivl�on/PlssttlName
Sr 0 kA---1 w .l I C—Sa it )C =E)
Assessors Parcel a Lot. Blodt- Plat IP/
. 4111111 ,
Applicant c ` AddrMa
cJ
1 City State r! Zip' Phone
`-- ' .T. e•,rr..Phos.
Contractor � •••����93
t state ;_ cep". Phon• r r�
Contact
, Business Phone
ISU S s L.—(0% .0 .7,1.�c7i1/. iG.37<fi✓� ,/
so
Dascribe Work EeL A'C.' / 0 e L ee/t/14c4v
Fans Evaporative Cooler Hoods ElectricFurnacellbuets Miscellaneous
Dryer Range_ • Oss Log',; Oas Water Htr. Solid Fuel/Wood Stove
0.10,000 CFM 10,000+CFM
Air Handling Units
r Refrigeration Systems/ 1-100M
101,500M 501-1,000M
Heat Pumps(BTU)
1,001.1760M Over 1750M
0-3HP 3-15HP 163OHP 30-5OHP 50+HP
Compressor .
,-6 Donets 6+Outlets
Gas Pipinc
11-100,0008TU " 10,.:00+87U
-s-V-Frred Heating System / 0`5 c
•
}wi.'ffay'tl J
certify that the above information as submitted by mels•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 / 0—/cAj -
OWNER OR DATE