1985, 01-24 Permit App: 00004049 Furance•
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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)
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