1986, 11-03 Permit App: 00013969 Furnace, Piping MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# (%4')q
Owner's Name t First MI
//: `�
Project Address(Street Name&Number)
Z---'— c2/ / 77/ CJ12/2
City State � L Subdivision/Plat Name
// 1
Assessors Parcel# 2-353V-(7Ls C/�/ i Lot Block Plat#. 38
Applicant f� Address 11
` ce(.1,_( /4„A
07.... 76- ".34,44-tie,
City State_ I Phone
ipv, - (444,s/ 1 � '?L4 /f
j - 6,r�!,
Business Phone
I, I'
Contractor Address
City State Zip Phone
Contact LicBusiness Phone
ensX /-/ /5-3 '.1/' X‘,`7 0 ,7a7-
Describe Work
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
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 15-30H P 30-50H P 50+HP
1-50utletsY 2 6+Outlets 2
Gas Piping J
Gas Fired Heating System 1-100,000BTU / ,r, 1U, OO+BTU
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.
'
SIGNATUR • ....-ort....-ortAPPLICATION '
OWNER OR .DATE /1 /-L-Vcr‘