Loading...
1986, 10-03 Permit App 00008020 Furnace, Wtr HtrMECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Project # 63C/,'0 Owner's Name --,----' Last Fi MI ,/,!/ G 4 �d r, Project Address (Street Name & Number) / 2/ .�/-/ -74.e/ o .0 City .. State Subdivision/ Plat Name Assessors Parcel # C7iiii ) Lot Block Plat # A lira % PP / ' 57 /�%t--) �- Address City a State Zip Phone Business Phone Contractor Address City J State Zip Phone Contact Licen e # Business Phone /escribe. l//i/f !/ ✓//�/7i1T l / GL/�`Z,--' �%1/ .‹.1,-1 77. /.%/J? %G f✓ C// • Fans / -Evaporative Cooler/ Hoods Electr' urns ucts' . 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) 1-100M 101-500M 501-1,000M 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP Gas Piping y 1-5 Outlets / !/ j 6+ Outlets Gas Fired Heating System 1-100,000BTU 10v,:.00 + 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 ooj_}ocal laws regulating construction or the performance of construction. SIGNATURE OF OWNER OR APPLICATION DATE