1988, 11-01 Permit App: 88003586 Furnace, Piping1-
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MECHANISAL PERMIT APPLICATION WORKSHEET �� eK
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOUUNDERSTAND
-&U& '7'S )(l t1 �(L
1 Owner's Name (Last) (First) (M)
Department Use Only
:- C U E _ \� l e -K
Project No.
2 Project Address (Not Mailing Address) Space Zip
/V, ft3 & ' f=ey /('n
3 City/Community
State 0Subdivision/Plat
Name
4 Assessor Parcel No.
Lot .
Block
16 Con for Firm Name
' i1 /;7 i i� e. 1 I4'el. C' C_
StreetAddress L
( ' / -- �/ /.eZG t'
17 Zip //
City •
State
Phone
18 Contact Person
License No
Phone If different than above
AumaooDs
8 Owner/Agent (if different than #1 above) 1 Business
Address
9 Zip
City.
State
Phone
(
15 Describe Work: c_//,.//4 A/6; [ n L) ,e,/L TC, c-;-_-, /9 f— tiA?/i,),/e
New 0 Addition/Alteration 0
-
Replace/Repair 0
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
8 VENT: . . Fan(s):
Evap Cooler (s):
Hood s):
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I 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. ft.):
15 COMPRESSOR/ HP: Less than 3:
3-15:
I
15-30: 130-50: 150+:
I j
16 GAS PIPING SYSTEM: Number of outlets: ) - c D
17 HEATING SYSTEM: 1-100,000 BTU: (/ ) -
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas 0 ; Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Alr 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 OF
APPLICATION
OWNER OR DATE