1984, 08-02 Permit App: 00001588 Furnace•
•
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M) Department Use OnJ)y
/V%4 L{ RER Ot/N Toj /y Project No. /
2 Project Address (Not Mailing Address) / Space Zip
E. 76.E L. ,'8E2ry 99 -?et
3 City/Community
SeoK/IW
State
.
Su
sion/PIf t Name
rCAe PC! d
4 Assessor Parcel No.
665 — &2-
Lot
I Block
16 Contractor Firm Name
6,44//YE2 I-URA/,9ec - 11-1EL Zo✓C
Street Address
4/ /- -2 bit-GE/09
17 Zip
99.202
City
S/°oK.-NE
State
GtJi4,
Phone
(579) 535 7 7i/
18 Contact Person
License No.
3'':)Z8
F378NT - 2.-..'':)---
Phone If different than above
8Owner/Agent (If different than #1 above) e et a r -k—
21614ite
Business Address
9 Zip
City
Phone
( )
15 Describe Work;" e..,,.7...,,,„._.
New ❑ Addition/Alteration ❑ Replace/Repair A(
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 s):
Gas Log (s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(S): Wail 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: C
7, 1`C)
100,001 + BTU: / D5- Ore
18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; 011 ; Coal ❑ ; Wood ❑ ; Solar ❑
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 OF
OWNER OR
APPLICATION
DATE 8 erL/