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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,:'• y � '114451#6-73';',,,.--;-;:,':-� �,� .,,� .,..z,,,•,-',-•.• +• ;J- ?',I.K y' ,r; •'7. 1 � ,� . �"i 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