1984, 12-20 Permit App: 00003793 Furnace•
Z
w
0-
a
5
0
w
LL
0
w
a
0
0
2
w
m
i
Z
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Sir . (Last) (First) (M)
..
Department Use Only .7(11 r7
2N„.\boa rY1tv-t`7'
Project No. � (�
2 Project Address (Not Mailing Address) ( Space Zip
f— .0\c\ 0e. mlo.,\ )l'% q`12 -(C
3 City/Colpgiun'ty
m
State
yrs ;
Subtlrvislonl Plat Name
r
Ci- ii cl,-414,.,--/ 2 9¢ 0
4 Assess r Parcel 0
I5h11—(rieI
Lot
i
Block i
I
16 Con,trac for Firm Name, t
e%%1 CI ..°C . Ac\C,eci y
c.-1,,,. ‘...\
Sir t Address
(033-3?'� A(vc3
17 Zlp
9/903
Cit
ate
Phone
(s35) 4S9 3
18 Contact Person
D. UI: G,Np"C-0
I License No.
I CAGt)t1
z ►71OCc
Phone If different than above
•-•) ( .,lz.C--)
8 Owner/Agent (if different than Al above)
Business
Address
9 Zip -
City
State
Phone
15 Describe Work:
New 0 Addltlon/Alteration
0
❑
Replace/Repair 0
10 Applicant Name
.C`5 S1t\f/_' (-1.---.‘4.C`01.3 .4 p
Street
Address
11 Zip City
Stale
Phone
I )
8 VENT. Fan(s).
Evap Coolers)
Hood (s)•
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
1 Range s):
Gas Loafs):
Wood Stove/
Sol Id Fuel.
Gas Water Heater(s):
11 UNIT HEATER(S), Wall Mount: Y N
Floor V 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 1.)•
15 COMPRESSOR/ HP. Less than 3:
3-15:
15-30:
30-50:
50+:
f
16 GAS PIPING SYSTEM Number of outlets: 1
17 HEATING SYSTEM: 1-100.000BTU: I.-
100,001+BTU•
18 TYPE FUEL SOURCE: Electric 0 , Gas t,f"°. 011 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION. Forced Air p#C.....-- Radiant 0 ; Heat Pump0
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 r h
OWNER OR �J �ccas�4. >
\\ APPLICATION
. t rash_ t J DATEpit� - an -24
-4
rt.C.--7`M.�-'�ti\ :.L.cvArl-Ce:a