1985, 10-16 Permit App 00008426 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1
Project # l) CO
Owner's Na e i Last ��]]/ First MI
Project Address (Street Nam 8y Num
/7a `/ CP e.4 t',4-
City
N5„,)� 1440 r--
State
i/ A.
Subdivision/Plat Name
Assessors Parcel #
Lot
Block
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor i
/41-1---A-7-1 /1)6 5L--- 4-
7C__) _.
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Address e.,/----x_e-xeY
.---0,3---7
CityPMe-
,
State
Zip
Phone _
Con,
License #'J
/x ,.�/Q /() Re %✓�_/%%)
Business Phone
_
-- 3 V- V 7 5✓.
Describe Work
e ---dz G -L '��-- --
Fans
Evaporative Cooler
oods
Elea ttl.
Miscellaneous
Dryer
Y
Range
Gas Log
Gas Water Htr.
id Fuel/W tove
Air Handling Units
0-10,000CFM
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
1-5 Outlets
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 of local laws regulating construction or the performance of
construction.
SIGNATURE OF/2F ,I� / APPLICATION OC %--
OWNER OR l