1985, 12-09 Permit App: 00009074 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project# fj15-7-
Owner's Name Last First MI
9 /4/
Project Address (Street Name & Number)
City
_;-./--_-,e2
State
G2,.'v
Subdivision/Plat Name
4,7
Assessors Parcel#
Lot
I Block
Plat #
Applicant , ,
Address
City
&State
Zip
Phone
Business Phone r /
Contractor
Address
City
State
Zip
Phone
Contact
License#
fl r7 4 16,7(r?-. (r?" i v
Business Phone
Describe Work -----
, , 1--- /—‘,777,7-irl-- --- Ad 742.„„ j....
Fans
Evaporative Cooler
Hoods
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)4�
1-4?v1
N .4 ' .• if
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
j`%
6+ Outlets
Gas Fired Heating System
1-t00,000BTU `
/X,
10,,,,.:00+BTU
d71,1-2-1-~ /D v.'
v s,'
i//h 1-%;
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2 -
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�� // APPLICATION
OWNER OR �/yy%!! ��.1/�� DATE /moo " �`"�'