1985, 12-24 Permit App: 00009306 Furnace1-
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i0c42-0301
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
.4/,/tt-0 1/3/n Pte./ (2 /fvL-l.
Project No
2 Project Address (Not Mailing ddress) Space Zip
et).
99-
3 City/Community
;d 41.e�L.L,
State
lv,Z .
Subdivision/Plat Name
ell I rye r cmcl� ',�P .
4 nosor�.Parcel No
1! i li i I~ OI ��
Lo /�
`(-/
Block
Cl
16 Conti for Firm Name
Street Address
17 Zip (-/
City
State
Phone I
Phone if different than above
18 Co 1 t Person
Y" t /0-4.--lj.c---4-
//
License No
/47/e/7T7/—
/ eC2Y z -/k/
8 Owner/Agent (11 different than Nt above)
Busl ess Address
9 Zip
City
State
Phone
15 Describe Work:
New 0 Addition/Alteration
❑ Replace/Repair 0
10 Applicant Name
Street Address
11 Zip
City
State
Phone
1 )
8 VENT: Fan(s):
Evap Cooler(s)'
Hood( ):
Duct (s)1�
Mi Ilaneous:
10 APPLIANCE'
Dryer(s)-
Range s):
Gas Log(s):
Wood Sto el �__
Gas Water Heater(s):
Solid Fuel'
11 UNITHEATER(S): Wall Mount: Y N
Floor: Y N
Suspended. Y N
c.
12 AIR HANDLING: 10,000 CFM or less:
More than 10,000 CFM:
13 REFRIG SYSTEM BTU: 1-100M:
100-500M'
500-1000M:
14 1OW-1750M-
Other:
Pressure Vessel (cu. 1.):
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: 7o, OOC> /5 / c. 6 —
/)(
100,001+ BTU:
18 TYPE FUEL SOURCE' Electric 0 , Gas Oil 0 , Coal 0 , Wood ❑ ; Solar 0
19 TYPE DISTRIBUTION: Forced Alr-Ts`% Radiant ❑ ; Heat Pump
1' Number of separate zones for any heating, A/C or air handling system.
6 a Fur1t` rcA
4- cFaNC FE,
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 to
construction.
, c,
/L1 CCJ
SIGNATURE OF
OWNER OR
2awe
AN
APPLICATION
DATE /- y/- Qs