1985, 04-26 Permit App: 00005287 Furnace0-
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
heC""f Ir iC ,t /618,449 At/
Department Use Only
Project No.
2 Project Address (Not Wiling Address) . Space Zip
S' 3/7 Pii7)1,r
3 City/Community
S—Air.-te
State
Le, -/d/
Subdivision/Plat Name
Lr 71,87A id-?
4 Assessor Parcel No.
2254 ( —' 11007
Lot
Block
16 Contractor Firm Name
�AcH� --S2'4 4//e Y `
Street Address
pt�ne/30'y ! ---"G St
17
7'92ter S—.
City
Sib fr. 4 -We-
State
4c '.
( ) I- 06dPV
18 Contact Person
.lam<fei,
I License No
A4icq-s-
.ia;1t
Phone If different than above
8 Owner/Agent Of dd fereMt than Ml above)
I Business
Address
9 Zip
City
State
Phone <
1 I
15 Describe Work:
New p.--- Addition/Alteration
0
Replace/Repair 0
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
( )
8 VENT Fan (s):
Evap Cooler(s):
Hood (s):
Ductysl 1.
tit dr
////1
r' '-x'
.c. r••rn••`4-
Miscellaneous:
10 APPLIANCE
Dryer(s):
I Range s).
Gas Log(s).
1 Wood Stove/
Sol Id Fuel:
Gas 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. t p
15 COMPRESSOR/HP' Less than 3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM- 1-100,000 BTU: e f
100,001 + BTU:
18 TYPE FUEL SOURCE' Electric &••. Gas 0 ; - OII 0 ; Coal 0 ; Wood 0 , Solar ❑
19 TYPE DISTRIBUTION. Forced Air Radiant 0 ; Heat Pump❑
1* Number of separate zones for any heating, A/C or air handling system.
L
JO tp perMrt
/are%feessrl�cee.
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.
GNAOF �° _gyp. DATE APPLICATION
OWNER OR ,o -G��¢