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APPLICRTION rOR MECHANZCAL PSRMIT <br />(To be filled in completely by applicant) <br />N1fME (Ownei') Joseph Bentvelzen <br />CONTF2ACTOR Natural Gas Equipment Ccmpzny <br />ADDRESS 1F11 Fact C.rand <br />TO DO WORK AT THE I•'OLZOS•TING ADDRESS 2 <br />PFiONE NUDSDED34 5460 <br />PHONE NUMBER z5$ 244� <br />LICENSE NU6IBER 3q7 <br />3 Floyt a•ienue <br />USE OF IIUILDING ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ R�PF�IR <br />D�SCF.IBE S90RK Ins.all two o�at�r hezters <br />SIG:7ED BY DATE_ — <br />_'ERidIT FE�S <br />e <br />nPPROVPD IIY <br />-'^ DATL <br />