1986, 10-14 Permit App: 00013609 Furnace, ACMECHANALPERMITAPPLICMITION WORKSHEET
PLEASE PRI NT'AND'.COMPLT ONLY;., $�l-�t SEPARTSJOFATHE CORM YOU,UNDERSTAND
.%I ;'a • k�A"4�r7ih'Jt�>t4 i �.(,
r. ia...r
I certify that the above information as'�m
submitted bye;ls�true and correct and further, agree that all pro-
visions of laws and ordinances governing thts:type of work, Including inspection requirements, will be com-
plied with whether specified herein or not: The granting, of a. permit does not presume to give authority to
violate or cancel the provisions of any state of local' laws::regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
AATECATION 42.r 7c_ 6
' Ownar'a Name Wt First M
/S/ . 04e0102204
ProlocttAA dress (Strreeett/Naino& uuummbeerr . .
City /1,/A ' /
fiAt
State /,�/
Subdiviskoonl Plat Name ,.,, I . ) "TV
twnaora Parcel 011 St/2._ — 1 t / _ t / ...
ro �•'
�.
Block
PI 1I AS,
C hM--vV�
Applicant wA
Address
City
Stets 1,.
•ZipFton.2d4
e 92n,3
Matinees ///q
in. s Phone 9z 0 7/ 00
Contractor
//77
�/f/✓//Lcj r//.L GO :...
e
ens
./G`..4,,e ,14//v
,
City
Stale
Stale
Lys
.a0r` A n�,
*>.�/
Phone S-5_47:
� J�/7//
//t , /
Cont D///V /%f»/$oiWay
License a •
2/INi✓tFic37,4✓i
Business Phone
./
Doa Wolk
ork D/G ,&44 4 e /i✓sis�-«—.t,2 c'D.✓ - c -
Fane
Evaporative Cooler
Hoods
Electric Furnace/ducts
Miscall us
Dryer
Range •
Gas Lop •;
Gas Water Htr.
Solid FusllWood Stove
' O-10,000CFM
Mr Handling Units
10,CO3 a. CFM
RefOperatlon Systema/
Heat Pumps (BTU)
'�//
1-10,0/M.4./d., //4/rat/ �./
Lf�J 4''L;/ //•L7
101-SOOM
5O1.1,000M
1,001.1750M '•
Over 1750M
Compressor
0-3HP
3.15HP
15-30HP
30-5OHP
50+1 -IP
Gas Piping
1-50utlets
... ."
5a Outlets
16.400+e1v L
9�
D.�is
O/gR.3 / a.
Fiord Healing System
1-,00.000BT1
�W
c,
z
r. ia...r
I certify that the above information as'�m
submitted bye;ls�true and correct and further, agree that all pro-
visions of laws and ordinances governing thts: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
AATECATION 42.r 7c_ 6