1984, 08-29 Permit App: 00002225 Furancew
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE -PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (L t (First) (M)Department Use Only CZ
`Project
No. 1.14
g of 44.'4,�/J Atm
2 Project Address (Not Mailing Address) / Space Ztui
.r' 34/ 0 ...e.0.0.1 -e-
3 City/Community City/Community
) v�
Staa 1 /
`C/a I-4
Subdivision/ Plat Name
222,5
4 Ass or Parcel No.
Lot
Block
16 Contractor Fi amen
StreetAddress
< ` Z (,/./�r>�
17 Zip
qq 7 i
City
State
..- f �
Phone 3 � ��0�
18 Contact Person
F
ansa No.
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business
Address
9 Zip
City
State
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):
EvapCooler(s):
Hood(s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s): 1
Range(s%:
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 10,000 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 Q✓/- Gas ❑ ; Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 14.-***--
! 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 0
APPLICATION
DATE Z-47 ``"Z/
•