1985, 11-08 Permit App: 00008827 Furnace, Piping 4 D
—.. MECHANICAL PERMIT APPLICATION WORKSHEET
r F PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M) I Department Use Only
c-VProject No.
2 Project Address(Not Mailinggddress) Space Zip
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3 City/Community State Subdivision/Plat Name
4 Asses 1
Parcel N 165 0b/Q Lot P I Block As
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16 t r Firm Name Street Address
17 Zip _ / City State) " Phone
` 5360Z GUQ _ ( ) ,0- 2 ,Va o
18 Con )(.2',1.-4-2-
act Person License No. Phone if different than above
(.2'z 4-2- , -idr - • „.... 1/E/9 TT/—/P h' GN
8 Owner/Agent(if different than 81 above) Business Address
9 Zip City State Phone
( )
15 Describe Work:
New ❑ Addition/Alteration ❑ Replace/Repair ❑
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: Wood Stove/
Dryer(s): I Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
Z 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
W
a 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
0
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
U-
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d 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
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C)
I-
Ci 15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 30-50: 50+:
Z
Q
W 16 GAS PIPING SYSTEM:Number of outlets: 2_.
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2
Z 17 HEATING SYSTEM:1-100,000 BTU: 45 O dOz.) ('n
oti c-/-72,moi)( 100,001+BTU:
18 TYPE FUEL SOURCE: Electric.-; Gas y Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Alr ❑yam Radiant ❑ ; 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.
I
SIGNATURE OF APPLICATION
OWNER OR a.tt_i_ / <_4_,<:, DATE //-6' -Y r