1986, 11-03 Permit App: 00014046 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE 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 ,i , APPLICATION
OWNER OR0/
�.Gl� �d DATE .f <
Project # / VO �'�i
Last First MI
Owner's Name /( /°%
� /
6/fT 7' / %, !PP
Project Address (Street Name & Number) 9
City
State
Subdivision/Plat Name
Assessors Parcel # J
2-2 33 ....445141/6
Lot
Block
Plat M
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor �
Addy�ss
Ci
. �'
S� e
z '2 C&_
zip
9'9,--/
Phone _
3 76
r 1 L_lcense #
�( ;� (a 3O, A. edh/9- lx-ifiz
Business Phone
- 347 <-7'� 5'
Describe Work
&-4'yet
" ! —
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water H!r.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000CFM
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
10v,�00 + BTU
,----).--L--v-e-tsLiz-e- ,v___..g,' _-----, -e-ee.)
li .i
+111x—r--"t-1\IEl
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 ,i , APPLICATION
OWNER OR0/
�.Gl� �d DATE .f <
E
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