application for hvac permit


Building Commission. 500 Quartermaster Ct., Ste. 200; Jeffersonville, Ind. 47130. Phone: 812-285-6415 • Fax: 812-285-6468 www.cityofjeff.net. 1. Location ...

APPLICATION FOR HVAC PERMIT Building Commission 500 Quartermaster Ct., Ste. 200; Jeffersonville, Ind. 47130 Phone: 812-285-6415 • Fax: 812-285-6468 www.cityofjeff.net

Date: ________________________________

1. Location information • Address of job: ________________________________________________________________ Lot #: ________ • Contractor: _________________________________________________________________________________ • Contractor address: ____________________________________ City ______________________ State _______ • Office phone: _______________ Cell phone: _________________ Email: _______________________________ • Contractor license number: ____________________________________________________________________

2. Property information • Property Owner: _________________________________________________________________________ • Address: ___________________________________________________ City _______________ State ________ • Phone: ___________________________________ E-mail: ___________________________________________

3. Project details HEATING • Fuel to be used ___________________

• Name of unit _____________________________

• Number of units __________ AIR CONDITIONING Tonage ______________________

Name of unit ____________________________________

Are the heating/air units: _________ New ________ Replacement

X ___________________________________________________________________________________________ (signature of license holder)

(date)

If you are submitting this application by mail, please include a self-addressed, stamped envelope for the permit to be mailed to you.

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