1984, 09-12 Permit App: 00002211 Furnace2
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MECHANICALPERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last (First) M)
- ///"` ___
Department Use Only
Project No
2 Prolect Address (Not ing Addr 1 Space Zip y
9
- /72o iU,au�e%/
3 City/Community State Subdivipion/Plat Name v
,anr.��, C.-(._.5--,/,_//e/s-/ter Pei/ 5- 3 E/
4 'Assessor Parcel No
.45 V/ —020
Lot
3
Block
.f 2.-
%2l/
16 Contractor Fir me
Street Address
17 Zip
C9 zo L
City
7^ e
State s-
Phone ) 3� rg�
P
18 Contact Person
Lice Ny
7
Phone It different than above
8 Owner/Agent (if different than t 1 above)
%
Business Address
9 Zip
City
State
Phone
I 1
15 Describe Work:
New 0 Addition/Alteration
❑ Replace/Repair 0
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
8 VENT' Fan (s)•
Evap Cooler(s):
Hoods).
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:Wood
Dr yor(a):
Range 1):
Gas Log(s):
stove/
Solid Fuel
Gas Water Heater(s):
11 UNIT HEATER(S): Wall Mount Y N
I Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10.000 CFM or less:
More than 10,000CFM:
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:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001+ BTU.
18 TYPE FUEL SOURCE. Electric E4-7-------
</ Gass0 ; Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION Forced Air ®! 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 OF
APPLICATION
OWNER OR DATE
7.f
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