1986, 10-06 Permit App 00013460 Furnace, Wtr Htr' MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project #
Owner's Name `A Last Firs MI
fri
Project Address (Street Name 8, Number)
/'. ‘70 % 6 xe a cf 7
City
S:Pz>
State
4-7,
Subdivision! Plat Name
\I et,A. skiU 1 Sv-FiU
Assessors Parcel # i �� �7
Lot 3
Block 1
Plat #
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractors ._ %
/� 1 tL i 5
,� ,/
. l/' a �, A�
Address /
e4 6' 15 67/ /CS/ ev
City
5/.,
State
u'r
Zip
%P'.)-
Phone
3..2- 7 3 SG'e?
Contact
License #
: IG'filli? y!>o in y
Business Phone
.'Cz.``{
Describe Work �t ' 4_ - g. •••c -G// "i lL1, :�� 4r I 14/e GL1Zt C ..cR l
Fans
Evaporative Coer
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr. S"O
Solid Fuel/Wood Stove
Air Handling Units
0 000 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
1-5 O{ ets " J
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10,, 00+BTU
18 - + 1 's- = 3 3
4
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 t
OF APPLICATION
OWNER O-_ .l DATE