1985, 03-27 Permit App: 00004767 Furancet -
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name >(Last)n �-�-{� (First) (M) .
13,w' \ (11)..f_ /�--V. A
Department Use Only
Project No.
2 Project A ress (Not ailing Address) Space Zip
3 VO 7 .--). 59a.ti s�
3 City/ mmunity
,_ k--ft-v��
State
.LJi 0
Subdivision/ Plat Name
4 Assessor arcel No.
Lot 1
Block
4/71C 7
16 Connir Name
t i C i -M->-
- `r.�1.?�/J 0. 2
Str tAddress y�
- \2 // \7- 1--i,+. ( '
17 Zip
7 J -o c.
I
State
cc>_
_
Phone
(_ ) 7,2,—.,,,LS .-
18 Contact Person
License No.
Phone if different than above
8 Owner/A ent (if dfferehannN_1ns
Cr
---above)
!Business
Address
9 Zip
�/ q (
City
State T ._
phone
15 Describe Work:
New 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:I
Dryer(s): Range s)!
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(S): Wall Mount: Y 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. ft.):
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 Gas 0 ; 011 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.
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
OWNER OR
APPLICATION
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