1985, 03-04 Permit App: 00004367 Furnacesz
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name n (Last) � (Flint) (M) .
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Department Use Only
Project No.
2 Project Address (Not Mailing Address) Space - Zip .
tS' Pk) F. !�j a J to - - - -' - '97o 3j
3 City/Com(nunity /�
State
Subdivision/Plat Name ' ' :`�',y�--
..../0----6-11-
s -Assessor Parcel No. "- ..
Lot
Block
iieD7 '
16 Contractor'Firm Name ((�1 ./p
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C.I.Q. A 1x?.-- - 4v.1.1�-�-0� Q
Str t Address
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17 Zip -
2Sel4
City
State -
Phone
CO
18 ContectPeroon
L� Icense No.
Phone If different than above
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8 Own gent (if different than l above)
Business
Address ... -
9 Zip _
-?/`.off b .
City -
State , -
L.).1 CN_
Phone-
( )
15 Describe Work: -
New "X Addition/Alteration
0
-
Replace/Repair 0 - "
10 Applicant Name /
r� eni,- s--' - 6_d */ 6 -
Street
.
Address
11 Zip -
.. 1
City
State -
Phone
( ) -.
8 VENT: - . Fan(s):
Evap Cooler(s): -
Hood(
): . '
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
Range s):
Gas Log(a):
Wood Stove/
Solid Fuel:
Gai Water Heater(s):
11 UNITHEATER(S): Wall Mount: Y N
Floor:
Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or less: -'
More than 10,000 CFM: ' -
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M: -
'14 - 1000-1750M:
Other:
Pressure Vessel (cu. It.):
15 COMPRESSOR/HP: Less than 3: -
3-15: •
15-30: , 130-C:
53 +. -
16 GAS PIPING SYSTEM: Number of outlets: '
17 HEATING SYSTEM: 1-100,000 BTU:
35/ /3o 6t' 1-0-- -
100,001+ BTU: -
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18 TYPEFUELSOURCE: Electric yd Gas ❑ 011 ❑ Coa ❑ Wood' ❑ Solar 0 -
19 TYPE DISTRIBUTION: Forced Air Radiant 0 ; Heat Pump❑
1* Number of separate zones for any heating, A/C or air handling system.
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 OF APPLICATION
3 -y Fs
OWNER O OR A» DATE