1986, 03-12 Permit App: 00010066 FurnaceI
MECHANICAL PERMIT APPLICATION WORKIHEUT
PLEA®E PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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
OWNER OR •
�� APPLICATION 7/,2_,A.‘DATE
Project # /er&
Owner's Name Last First MI
Mr' ,6q FFA e / / 1
Project Address (Street Name & Number) i
AV 76,3 '/»,` 1I4/
City /
{/�/�
State' / y�
Subdivision/Plat Name
Assessors Parcel # % 75 . %3 ' J• 7
Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor 7ress
8%) /(�� L A / / ` /)6 v._. A. 1 1Z.6-7/-42a/r
City
S Pc5ii )
State Zip
ct) /1.__9 ' g
Phone
3 4-7--X97.&—"
573
.
,ract p
License #
eVao2,'O 'o / 7 /z
Business Phone
._ 5L/-y975—
Describe ork
Fans
Evaporative Cooler
odds
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Units
0-10,000 CFM
10,000 + CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping /
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
L ,
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 OF
OWNER OR •
�� APPLICATION 7/,2_,A.‘DATE