1985, 03-07 Permit App: 00004434 Furnace*
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
or r I_ _ '.■rte- .. r
Department Use Only
Project No.
2 Project Address (Not Mailing Address) Space Zip
3 3/ 6 kit. OLILL,60 t
3 City/Community
1 State,,'' ``
ll._J tU
Subdivision/Plat Name
4 Assessor Par I No.
Lot I
Block
� { %
16 Contractor Firm Name
CL-t1-t1n
---)•,-1--1,—-.1a, k_}--
Str
ddress
.°J it
17 Zip
Cit
State
Phone
18 Contact Person License No.
Phone if different than above
I
8 Owner/Agent (If different than #1 above)
cQ J L
Business
I ()J
Address
. () a c0 3 c()._
9 Zip
C%40! t�
City
State
1...1..1c,..r
Phone
(
15 Describe Work:
New Addition/Alteration 0
Replace/Repair 0
10 Applicant Name
f so
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
Evap Cooler(s):
Hood s):
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:I
Dryer(s): Range s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(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. t.):
15 COMPRESSOR/HP: Lessthan3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU: /S 'LL
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric 0 ; 011 0 ; Coa 0 ; Wood 0 ; Solar 0
yyGas
19 TYPE DISTRIBUTION: Forced Air ,p 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. v MACE
ats(- ,:*TING.
SIGNATURE OF r . f'E
, a APPLICATION
OWNER OR OKAN, A99DATE 3- -