1984, 09-05 Permit App: 00002130 Furnace•
z
Z
W
a_
a
5
0
W
0-
O
W
0-
>
1-
0
z
2
W
2
MECHANICAL PERMIT APPLICATION WORKSHEET
.PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
'797
1 Owner's Name (Last)�// (First) (M)
-liAr /'RJ L i. i`/✓ST• co
F,yAddress
Department Use Only r
Project No. i3�
G
I(
2 Prolecf�(Not Malting Address) Space Zip
e' • //if a- tit/ 14 c1
3 City/Community
State
Subdivision/ Plat Name
4 Assessor Parcel No.
Lot
Block
16 Contractor Firm Name
S/' -1:71N ( / '/'/l
Street Address
1 - / C ) /V. a X' 4-
17 Zip
(%Du 7
City
SJ.c.
State
G✓5�^.
Phone
( ' ) 3',r "/Yi/
18 Contact Person
13 a r3
License No.
ry .> 5' b"
/1/
Phone if different than above
8 Owner/Agent Of different than 41 above)
Business
Address
9 Zip
City _
State
Phone
15 Describe Work New r&
/� -- g -6, -_,a --,z; / 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)'
1 Range sp
Gas Log(s):
Wood Stove/
Solid Fuel
Gas Water Heater(s):
11 UNITHEATER(S). Wall Mount: Y N
Floor. Y N
Suspended Y N
12 AIR HANDLING. 10,000 CFM or less:
More than 10,000CFM• _
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:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric Qc- Gas 0 ; Oil 0 ; Coal 0 , Wood 0 ; Solar 0
19 TYPE DISTRIBUTION. Forced Air ,, Radiant 0 ; Heat Pump
1* Number of separate zones for any heating, A/C or air handling system. ,c)ok"-._111-`-,-
)
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