1985, 02-26 Permit App: 00004288 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)
Department Use Only
L /% c .£ P .'"k
Project No. -4-2S'
2 Project Address (Not Mailing Address) /� Space Zip
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3 City/Community
I State
Subdivision/ Plat Name
4 Assessor Parcel No.
Lot
I Block
16 Contr or Firm Name
Street Address
17 Zip 99
City /
State
,
Phone y/7y07J7
18 Contact Person/
License No.
I ag.lI 7n aS-9/Jq
Phone If different than above
8 Owner/Agent (if different tha 1 above)
Business Address
g Zip
City
State
Phone
15 Describe Work:
New E Addition/A teration A,.-• Replace/Repair ❑
10 Applicant Name
Street Address
11 Zip
City
State
Phone
8 VENT: Fan(s):
Evap Cooler(s):
Hoods):
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:Wood
Dryer(s):
Range s):
Gas Log(s):
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.):
15 COMPRESSOR/HP: Less than 3: 13-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas E ; 011 ❑ ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; 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 0
OWNER OR
APPLICATION Z /�
DATE l/