1986, 04-21 Permit App: 00010734 Furnace, ACMECHANICAL 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-
piled 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.SIGNATREOF
OWNERU OR— /-ice/ `"'��"'" 'i �i DATEICATION
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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-
piled 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.SIGNATREOF
OWNERU OR— /-ice/ `"'��"'" 'i �i DATEICATION