1988, 11-10 Permit App 88003635 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project #
Owner's Name Last First MI
Project Address (Street Name &lumber)
N 3 ‘I 4 ;-14-
City p�., y fj
C7V1-Ari1-
State
\.tipt
Subdivision/ Plat Name
Assessors Parcel #
t(055 --.046/12
Lot
Block
Plat #
Applicant p9 /�
_
Sfi� v, - 2 I d—' 2r/c
Address Li / ,��/ c, �^
k i 1 I3o 37
City State +
Ai t i,imii Li -kl. ih,s ..
Zip
9 9 Q.k
Phone
6' 1.L1,9
Business Phone
Contractor
S+Z r‘>r},Zirz l LIWLY,) -Air
Address
At' i goi 39
City
Ai LA +'r\ LAk i.
State
w'A.
Zip
I ° a s—
Phone
.)>6—,s.a17
Contact
License #
Business Phone
Describe Work (' / c
i4-1
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
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
15-3OHP
30-50HP
50+HP
Gas Piping
1-5Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10v,;,00+BTU J
siDM
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 y Q
OWNER OR / 1�I:.m,..(t(Azzi
APPLICATION
DATE