1986, 09-23 Permit App: 00013375 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET c —"—
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) 0-->
� (M)
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W
114
Q
W
Department Use Only 7)/4 -7
Project No. / /
2 Project Address (Not Mailing Address Space Zip
13/5 ,, 6&1'/SH
3 City/Community
5 Olkiq N f
State
1)'9
Subdivision/Plat Name
4 Assessor Parcel No.
Lot
I Block
16r Firm Name �_—�Street
r7f,.z�o� Firiv >�
Address
�// T''c NT
17 Zip
g9e71 0 e
City
Cep"/"1-4v('--
State
,/,)n
Phone
( ) 9ai?— 8a 6—.Z.
18 Contact Person /{A \
License No.
ALLIDICODS
Phone If different than above
8 Owner/Agent (If different than #1 above)
•
usiness
Address
9 Zip
City
..
State
Phone
( )
15 Describe Work: 64E -e,-/-0 645
If/,J , 0U- - New 0 Addition/Alteration..
/
f
- Replace/Repair 0
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
8 VENT: Fan(s):
EvapCooler(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
Ftoor: 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:
i
1000-1750M: -
Other: -
Pressure Vessel (cu. t.):
15 COMPRESSOR/HP: Less than 3:
315: - -
15-30:
30-50:
50+: -
r i
18 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU: _
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric 0 r Gas • v Wood 0 ; Solar
19 TYPE DISTRIBUTION: Forced Alr 0 ;'; " ': `-Radiant ` 0 ; " Heat Pump❑
1* Number of separate zones for any heating; AIC or al r handling system.
I certify that the above information as subinitted,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:: '.': F
SIGNATURE OF' APPLICATION
•WIC ,,. DATE
OWNER OR , :,:s.,_1t mean.
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