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1986, 01-06 Permit 00009350 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Project # Owner's Name rLast First MI —l�, Project Address (Street Name & Number) %/.;'/3/e2r i it�.�� City ,Vo i :4/17.- State L-,.. Subdivision/Plat Name (ip PO 3/41—N i ri Assessors Parcel # Lot Block Plat # Applicant ��JJ ..5, Address City State Zip Phone 9N Business Phone Contractors _ /�'',//V- /E- / ' e Address ,%v44`x //:a' . City State Zips, , Phone ' r Coptaa License # Business Phone Descnbe ork l 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 15-30HP 30-50HP 50+HP Gas Piping 1-5Outlets 6+ Outlets Gas Fired Heating System 1-100,000BTU 10 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. =AEU�j�� R OR i APPLICATION DATE /