1986, 07-01 Permit App 00011994 Furnace MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project M j / iL�
Owner's Name Last � First
MI G,
r.�Li /7..L1�-7L�1__/ l
Project Address(Street Name&Numbed
4.31c - Eic.r,44 Cliff/2
City State Subdl s /Plat Name
Pccl- 04-20 A vu _
Assessors Parcel M 065 / --/T// /e/ Lot Block Plat e
Applicant /7/' Address
, "0-A-' Jalf,'W/.-A1--/ -7".;- ''.-;-' -u.' dEA..1
City State Zip Phone
Business Phone
Contractor Address
ra-- 1- ----. (,„,;_i'_ _%i p ''' -
Q. e 47O7
City State Zip Phone _..-9_ .
Contact
�ili2/i.1.Lr ! �`� q
. ;7i)
t larw Business Phone
Describe Work
11 r- '1/-fr727,--64_
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water H1r. Solid Fuel/Wood Stove
I
Air Handling Units I 0 10,000cpiv1 r 10,000+(:FM
Refrigeration Systems/ 1-100M _ 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Com
pr« 0-3HP 3-I5HP 15-30HP 30-50HP 50+HP sor
Gas Piping 1-5 Outlets 8+ Outlets
Gas Fired Heating System 100,0 Tu'. 10.,,..00+BTU
I
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 /jg,
n1A/nlPa CIO �" -d)t0 — C .A inaTr-