1987, 06-22 Permit App: 87001924 Furnace, AC v.
MECHANICAL PERMIT APPLICATION WORKSHEET
v
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
A-s
BecO
Project# F?,./`/gf_7/
Owner's Name Last /!irstt f MI
-Et rq t✓N sew J + (Cil A Rd
Project Address(Street Name&Num r)
L., - X6 07- 10f _
City State Subd' ' ' /Plat Name
AsseParcel# Lot Block Plat#
® 9 — 62.64 1 1 '2..
Applicant Address
City State Zip Phone
1 -a- _ 53s- 3,t b
Business Phone
Conttactor
Address
7ZA( ( to l't� /4 cm-ra4— E- - / 2 7/0 �iUPiA-AU,
Cit State Q
4014 Ma_ V,. .hat Phone , . C " /ü o
CoLicense#
-/ Me Y retiLs Am QL1A-1-1 L...--- fq 3 A)
Business Phone
DescrW rk 4) 1
l'Lefle 6-0- &vsi
0(---44-44mcco-
Fans Evaporative ler Hoods Electric Furnace/Ducts ' Miscella eous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
0-10,000 CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100 meq? 101-500M 501-1,000M
Heat Pumps(BTU) r./,J,0t,e).
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-3OHP 30-50HP 50+HP
1-5Outlets 6+Outlets
Gas Piping
Gas Fired HeatingSystem
1- B,T,Uy�p /' 10,,;.00+BTU
NC74000 ,--1,yi.
(5 CC
I
r00
, r° 1<
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 Xle ;,r APPLICATION '
OWNER OR .DATE -y G o