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1985, 12-24 Permit App: 00009306 Furnace1- Z w i a 5 w w LL 0 > w 0 0 Z w Z 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