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1984, 11-20 Permit App: 00003538 Furnace, Heat Pumpr . " 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 Only Project No. 2 Project Address (Not Mailing Address) Space Zip; 7llo 1-41r1'9o.,r7� ©�,�',e 91es37 _'Ze 3Cittyy/Community State G/'V� Subdivision/ Plat Name / 1i Yilb(�Vi �bYYi� l-° 4 Assessor P`arcelN•�o. (}� Lot Block 16 Contractor Firm Name _ Stree Address 17 Zip�J ss�� City y - / State Phone✓, 18 Contact Pefson _;)/ems r. i�/�� License No. , X, ��37*^/ " Phone if different than above 8 Owner/Agent (if different than k1 above) Business Address 9 Zip City State Phone ( ) 15 Describe Work: 777/3V7,7473- 7-77— 7VP 1/1f/19Zi,1i g6'Z,&e, New ❑ Addition/Alteration Replace/Repair X 10 Applicant Name Street Address 11 Zip City State Phone 8 VENT: Fan (s): Evap io Hood(a): Ducts) 1: Miscellaneous: 10 APPLIANCE: Dryer(s): Rang ) as Log Is): Wood Stove Solid Fuel: Gas Water Heater(s): It/ 11 UNITHEATER(S): Wail t N Floor: Y N Suspended: Y N 12 AIR HANDLING: or less More than 10,000 CFM: 13 REFRIG SYSTEM BT 1-100M: 10D-5WM: 500-1000M: 14 1000-175OM: Other: Pressure Vessel (cu. ft.): _T 15 COMPRESSOR/HP: Less than 3: T-315: 15-30: 30-50: 750-7 16 GAS PIPING SYSTEM: Number of outlets: y U: 17 HEATING SYSTEM: 1-100,000 BTU:! L-��aX ��� �/` :LilflWa 6;1'�V' 18 TYPE FUEL SOURCE: Electric �; Gas ❑ Oil ❑ Coal ❑ Wood ❑ Solar ❑ 19 TYPE DISTRIBUTION: Forced Aird Radiant ❑ Heat Pump 1* Number of separate zones for any heating, A/C or air handling system. e ,2_,er. 00 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 0 14 APPLICATI OWNER OR DATE�`"�