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1985, 01-24 Permit App: 00004049 Furance• H z w i a 5 a w 0 w > E- O z tr w m i z MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name (Last) (First) (M) Y l i C kti ( Department Use Only Project No. 2 Project Addr (Not Mailing Address) Space Zip S. 170 / Lo ks1,77 A 3 City/Community SPO k4nc2.. State tl..sIS/4- Subdivision/Plat Name 4 Assessor parcel No. i Lot 1 Block ./e/f1-9 16 Contractor Firm Name SM (T Ii NX -4 i svc) Street Address _ j. - /U, ntoaA 17 Zip 9 ?01 City Sr- State w4- Phone ( ) 30).8'-yy3/ 18 Contact Person License No. if?S—UVJ Phone If different than above 8 Owner/Agent (if different than 41 above) Business Address 9 Zip City State Phone ( ) 15 Describe Work: New 7f. Addition/Alteration ❑ 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 s Miscellaneous: 10 APPLIANCE: Dryer(s): 1 Range s):1, Gas Log(s): Wood Stove/ Solid Fuel: Gas Water Heater(s): 11 UNITHEATER(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: 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 Al ; Gas 0 ; Oil 0 ; Coal 0 ; Wood ❑ ; Solar 0 19 TYPE DISTRIBUTION: Forced Air jam.; 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 OFI�) APPLICATION OWNER OR w "'�` DATE / - at(" �S