1985, 05-22 Permit App: 00005836 Furnace, Heat PumpO
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner (First)(M)
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Department Use Only t°
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Protect
2 Projecty6tlr/(N • ( /c ' Address) Space Z��
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3 . .mmunil
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State
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Subdivision/ Plat Name l�
LC (L- OW Ci ••lPJ
4 A essor •ar el No.
0542— &3o
Lot
2
Block
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16 ira for F Name �r�/z YCI! ��
Str ,..2Sf-42
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Zip
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Or; --4-
State
ZA151-
Phonej
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18 Contact Person
License No. %
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Aft/ne7
Phone if different than above
8 Owner/Agent Of different than 01 above)
c./
Business
Address
9 Zip
0,_2")„4„ .(
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.E1/5///Jt%x_____
Stat
Pho ( ) 7- (tf(1)
15 Describe Work•
New ❑
`
Addition/Alteration
❑
Replace/Repair 1
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
8 VENT- Fan(s):
Evap Cooler(s):
Hood)
Duct(s)1'
" r -"v
Miscellaneous:
10 APPLIANCE'
Dryer(s):
1 Range s)'
Gas Log(s):
Wood Stove/
Solid Fuel.
Gas Water Heater (s)'
11 UNIT HEATER(S)' Wall Mount: Y N
Floo : Y N
Suspended. V N
12 AIR HANDLING: 10,000 CFM or less:
More than 10,000CFM:
13 REFRIG SYSTEM BTU /1 (7-7.)
(/ / /
100-500M:
500.1000M•
1000-1750M•1-100M'e
14 10-175oM'
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
���000/_;
18 TYPE FUEL SOURCE: Electric y Gas ❑ ; 011 0 ; Coal 0 ; Wood 0 ; Solar ❑
`Al
19 TYPE DISTRIBUTION: ForcedFr Radiant 0 ; Heat Pump
sal* Number of separate zones for any heating, A/C or air handling system.
Jam/ 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.
OWNERSIGNAR O OF
R O
• DCATTV
DATE