1989, 02-20 Permit App: 89000340 Furnace/o
ate%'
MECHANICAL PERMIT APPLICATION WORKSHEET—/6-)0,9
PLEASE PRINT AND COMPLETE OKILY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) I' (First) y/- (M)
T!
Department Use Only
C / L ✓ /L/c L .t%um,/
Project No.
2 Project Address (Not Mailing Address) Space Zip
c • //8c v , .E'zoe2iC.s/
3 City/Community
State
Subdivision/Plat Name
4 Assessor Parcel No
095`//— x305
Lot
Block
15 Contractor Firm Name
//��erA-ed, a0
Street fAddress
,J / \
ILV/
/ ✓✓KQ
Com- . / /il-'�
17 zip 1 elty •
9‘9g,'‘' _.4---A72.--e--,--
State
�s—
Phone
( ) 99cfi— gam---.)
18 Contact Person
License No.
Phone If different than above
8 Owner/Agent (If difteront thnn #1 above)
1 Business
Address
9 Zip
City
State
Phone
is Describe Work enzi e OUT— c] s 70 c%'S
New 0 Addition/Alteration
0
Replace/Repair ,K
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
( )
d VENT Fen(sl.
Evap Cooler(s):
Hood )'
Duct(s) 1.
Miscellaneous'
10 APPLIANCE:
Dryer(s).
Range s)
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s)-
11 UN IT HEATER (Sy Wail Mount Y N
Floo • Y N
Suspended: Y N
12 AIR HANDLING' 10,000CFM or less:
More than 10,000CFM:
13 REFRIG SYSTEM BTU: 1-100M
100-500M.
500-1000M:
I a 1000.1750M'
Other:
Pressure Vessel (cu t.)
i5 COMPRESSOR/HP Less than 3: 3-15:
15-30:
30-50 150
1
J
16 GAS PIPING SYSTEM: Number of outlets: C/ ) 5-D00
D
`��-1 -
1; HEATING SYSTEM 1-100,000 BTU. CI \l cf' Ol9
100,001 + BTU'
IS TYPE FUEL SOURCE Electric 0 ; Gas 1 , 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 y
OWNER OR DATE o`/0gD/8%