1991, 11-11 Permit App: 91008094 Furnace, Piping*
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Ow 's Name (Last) ' (Fir (M)
Department Use Only
D (W0S
'/ _ddrlesss))
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Project No.
2 Project Address((Not Mailing Address) /J Space q Zi/p%
lg ie( g' nPi le/ta
3 City/Community
State
A
Subdivision/Plat Name
4 Assessor Parcel No.
Lot
Block
16 Con ractor Fir Na
CE-Fei6F-A-7-76Ar
Street Address
/04.t EE\/4 -0- 2,..
17 ZipG� �'
Cit
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,
Phone G1) 5-5,5-.'
Phone if different than above
18 Contact Person
Du / IE5r
License No.
D
1i il4z.
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New ❑ Addition/Alteration
kr. Replace/Repair ❑
10 Applicant Nam4..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.):
15 COMPRESSOR/HP: Lessthan3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU: ' 13^/�(�, ,r
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ID; Gas k; Oil ❑ ; Coal D ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air K.; Radiant ❑ ; Heat Pump El
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
OWNER OR
APPLICATION ,
DATE 1� �/4 l