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1985, 06-17 Permit App: 00006044 Furnace, AC
z W 0- a 5 a W LL W 0- k- 0 z Q co W m 2 Z MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND g7cc 4S 1 Owner's Name (Last) (First) (M) ntorAt ez/e/V,7 Department Use Only Project No. 2 Project Address (Not Mailing Address) - Space Zip • /1 f// , ,a s - 4,v 99.12. 3 City/Community JPor I State ! Subdl n/ Plat Name �ooaTU ,ty No 4 Assessor Parcel No 085/','- 6351 Lot Block g1 / �/ ld0Y` 16 Contractor Firm Name S4//e .tee, -2' i— & Street Address ,,g4 4e*'4'396 17 Zip 192ez- City . attou/, State f1/419, Phone .2oq )53. -/7// 18 Contact Person I License No. 'Phone If different than above 8 Owner/Agent (if different than #1 above) Business Address 9 Zip City State Phone ( ) J �l 15• / Describe Work. yr(% ✓//L� 4 11//t' Cdr/V.v, / NJn.. ali/Z „ New ❑ Addition/Alteration nei✓//C, 0 Replace/Repair 0 10 Applicant Name Street Address 11 Zip City State Phone 1 ) 8 VENT: Fan(sp Evap Cooler(s): Hood Is) Duct(s) 1• 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 Floor Y N Suspended: Y N 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM: 4, Gf.4//✓o r f/✓/S 'eV/ `/% 13 REFRIG SYSTEM BTU: 1-100M: co 00/4 40)44/ 1W -500M• 500-1000M: 14 1000-175oM: Other: Pressure Vessel (cu. L): 15 COMPRESSOR/ HP Less than 3: 3-15: 15-30: 30-50: 50+. 16 GAS PIPING SYSTEM' Number of outlets: G.OD 17 HEATING SYSTEM: 1-100,000 BTU:` iNX e2Z 2>- %ere9fi�, �� ♦ BTU: 18 TYPE FUEL SOURCE. Electric 0 ; Gas 0 ; 011. Coal 0 , Wood 0 ; Solar 0 19 TYPE DISTRIBUTION: ` Forced Air Radiant 0 , Heat Pump El 1* Number of separate zones for any heating, A/C or air handling system. ,22©O 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 % J,440 mac' yG OWNER OR%c APPLICATION DATE �'