1984, 09-19 Permit App: 00002619 DamperF
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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
e
/ `-'ii( "-71/ ( .
Project No.
2 Project Address (Not Mailing Address) Space Zip
/3723.CDI.21 - ryas
3 City/Community
State
Subdivisio �/ /Plat Name
iueiCr�/l� C & . r,26 -VV ZZ -
4 Assessor Parc I No.
��y- �7�2—
Lot
Block Firs �1/
1 Hl 7 261
16 Contractor Firm Name
REYNOLDS FURNACE CO.
N 6101 °11T'.—irfI IN
Street Address
17 Zip SPOKA
Ph:
MYWA 99208
327-1924
State
Phone
( )
18 Contact Person
2122/ 1.0, , �4
LicenseNo.
_ V t0 //,ire
Phone If different than above
8 Owner/Agent Of different than /11 above)
Business Address
9 Zip
City
.State
Phone
( )
:} �/� �� �J
15 Descri WorkAL,
rt - .Q f�.V /12vr✓.�i3-l.Ne' fl ✓it/A t—, Addit��/q eration Replace/Repair ❑
10 Applicant Name / I 0
Street Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
Evap Cooler(s):
Hood s):
Duci(s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):Range
5):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNITHEATER(S): Wall Mount: V N
Floor: Y N
Suspended: V N
12 AIR HANDLING: 10,060 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. 14:
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:
100,001+BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; Oil ❑ ; Coal 0 ; Wood 0 ; Solar ❑
19 TYPE DISTRIBUTION: " Forced Air 0 ; Radiant 0 ; Heat Pump CI
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 I l APPLICATION
OWNER OR '7%11-+ 1 l.( l_:� J_,fili/�(:!�— DATE � �%. f