1984, 09-24 Permit App: 00002661 FurnaceMECHANICAL 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
//�
f 441 --t ( th obi( L7
z
Project No
2 Project Address (1101 Mailing Addr s) ' Space . �ZZiiip
Lk
J
3 City/Community
Stale
Subdivisionq,{Pial Name
J"f rkthera aNe4a
4 Assessor Parcel No
oQrSS -- aio&
Lot
6
Block
//
210e0i
16 Contractor Firm Name -
Sheet- ddress
17 Zip
9Z
City., 7
J,n Ah�
2
State
/-
Phone JJ//f_
( ) 7L19-//�0
Phone if different than above '
,-37t
18 Contact Person
'cense No.
S% -Cti% -6R
- _892 /I,%._-
8 Owner/Agent (if different than 91 above)
1
Business Address
9 Zip
City
State
Phone -
( 1
15 Describe Work:
New 0 Addition/Alteration
0 Replace/Repair /H
10 Applicant Name --,h
Street Address /_ A'
11 Zip
97vlC
City
DKt
State
`ai
Phone
( )play- s7(�
8 VENT' Fan(s):
EvapCooler(s):
Hood ):
Molls) 1'
Miscellaneous:
10 APPLIANCE:
Dryer(s):
Range s):
Gas Log Is):
I Wood Sto e/
Sol Id Fuel'
Gas Water Heater(s):
11 UNIT HEATER(S)' Wall Mount V 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: Less than 3:
3-15:
15-30:
30-50:
50+'
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM 1-100,000 BTU: / -6/ 000 _oo( el.q p
100,001 + BTU:
18 TYPE FUEL SOURCE. Electric 0 ; Gas Oil 0 ; Coa 0 ; Wood 0 , Soler 0
r
19 TYPE DISTRIBUTION. Forced Air 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 .e com-
plied with whether specified herein or not. The granting of a permit does not presume to give aut ority to
violate or cancel the provisions of any state of local laws regulating construction or the perfor ance of
construction. / 1
SIGNATURE OF �)�� APPLICATION
OWNER OR 46W Y' 1�1-61/�( Ala DATE
21'i