1987, 10-12 Permit App: 87003562 Furnace, Piping6e5
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
PZ_SCO
1 0 ner's Name (First) ,
/2/
DepartmentUse Only
2 Project Address (Not Mailing Address) Space Zip
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3 City/Community
State
-Z)f,)
Subdt Islon I Plat Name
ikerDLE--••-/ 1 b O
4 Assessor Parcel No.o
I -- ogos
- 12--
k
-
16 Contractor Firm Name
, ,- , ;," -,:7(''X'
Street AddressC'(
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„/Z•2--_/
17 Zip
17
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City /
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State
Phone
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18 Contact Person
License No.
______
Phone If different than above
M111940004
8 Owner Agent (if different than #1 a v
.-- -
1
Business
Address
9 Zip
City
State
Phone
( )
15 DescribeW rk:
New 0 Addition /Alteration
0
Replace/Repair 0
10 Applicant Name
I
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan (s):
Evap Cooler(s):
Hood (s):
Duct (s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer (s):
Range s):
Gas Log (s):
Wood Stove/
Solid Fuel:
Gas Water Heater (s):
11 UNIT HEATER(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.):
I 15 COMPRESSOR/HP: Less than 3: 3-15:
15-30:
30-50:50+:
' 16 GAS PIPING SYSTEM: Number of outlets:
1
17 HEATING SYSTEM: 1-100,003 BTU:
0
100001+ BTU: / ‘ ,
)
18 TYPE FUEL SOURCE: Electric 0 ; Gas Oil 0 ; Coal o ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Alr 0 ; - Radiant 0 ; Heat Pump El
1* Number of separate zones for any heating, AIC 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
OWNER OR
APPLICATION
DATE k)/