1985, 06-05 Permit App: 00005916 Furnace MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Q
Project# 6Q//
Owner's Name Last First MI (C,
Project Address(Street Name&Number)
City State Subdivision/Plat Name
(C)00d LAWN r)• k
Assessors Parcel#2_1/56 Lti._ Q5/ Lot / Block Plat#
Applicant Address
,,e/e..ita
City e KCC�it-� state 'I )c, Zip 912/2-. Phone=199z g-- V`f'g9
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Business Phone
Contractor Address
T6- ' c P ' 6 . W�
City State Zip , Phone
Contact _ License# Business Phone
d 'ta';e --A--r — — .2.2A)4".
Describe Work
S-, . J -< a.e e..�
-
Fans Evapora iveCooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Soli
Fuel/Wood Stove
?IAA/rut-a-
0-10,000 CFM 10,000+CFM
Air Handling Units
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor
0-3HP 3-15HP 15-3OH P 30-50H P 50+HP
1-5 Outlets 6+Outlets
Gas Piping
1-100,000BTU 10.,,,:00+
Gas Fired Heating System BTU
M. ox, Ara_.
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
OR -r�. D — L I. 1>t..�� .DATE 7E-6-
OWNER