1985, 05-28 Permit App: 00005710 Furnace, Piping1—
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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) (First) (M)
[ _ 171,4 d/i%fij / ylei--
Department Use Only
Project No.
2 Project Address (Not Mailing Address) Space Zip
C. c9 "QCRE�rA
3 Cit /Community I State
X0/49 4(.._ (�� 2
Subdivision/Plat Name
4 Assessor Parcel No. C 6241 J1L0t
I
Block
57/0
1.600v tractor Firm Name/
Street Address4
17 ZipCity
99C1oa _
-S-;e),4//e./9ti_g.-
State
1.v�
Phone
(S09) 66--73
18 tact Personp
%/-IC: i�;Ai
License No.
-__-.82/70 -- O
Phone if different than above
8 Owner/Agent (if different 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):
EvapCooler(s):
Hood(s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I Rangep):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(S): Wali 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: Lessthan3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets: / d
17 HEATING SYSTEM: 1-100,000 BTU: //
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas X; Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; 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 /) APPLICATION
OFFER--OR���.� ��2/ DATE `�a/45