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.
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R OR i
APPLICATION
DATE /