1985, 05-01 Permit App: 00005356 Furnace, Piping*
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MECHANICAL PERMIT APPLICATION WORKSHEET b v
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last (First) (M)
T7. ODAISTR V & Tv ON
Department Use Only
Project No.
2 Project Address (Not MailingAddress) Space Zip
6". eg6 D... 0. 0,4?f'7t 4 DA2 i
3 City/Community
State
Subdivision/Plat Name
4 Assessor Parcel No.
/5efei
Lot
L Block
535
16 ntractor Firm Name , / �I
`'* A9 idA.�./2 E.D / 47 /NG 7`- �` x) d4.1D 1776A1/A/G
Street Address
6, 4/�o3 D 55✓oAi
17 Zip
City
State
%
Phone
( ).6-36-- 7 3�
18 Contact Person
i / / •a_349/eo
License No.
- O
Phone If different than above
8 Owner/Agent (if different than #f..ve)
Business
Address
g Zip
City
State
Phone
( )
15 Describe Work:
New 0 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):
I Range(b):
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. t.):
15 COMPRESSOR/HP: Less than 3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets: / 6-- --
17 HEATING SYSTEM: 1-100,000 BTU: /
/
100,001 +BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas X Oil 0 ; Coal ❑ ; 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 C /�f /�i Q� l
OWNER -OR Glq�e/�
APPLICATION
DATE
cis/g6-
*