1984, 09-18 Permit App: 00002402 Furance, Heat Pump1—
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
__L.../CQ.•
Department Use Only
Project No.
494
2 Project A dress (Not Mailing Ad .41 Space Zip
y• / Ka 1l e, F9lo ro
3 City/Community
State •
W a.-
Subdivision/Plat Name
4 Assessor Parc I No.
_
Lot
Block
16 Contractor FirmnnName
Str Address % y
17 Zip ('
Y 7 01-0 t
City
State
a`.
Phone
( ),L6P—fP.,� J L
18 Contact Person
Licensee No.
Phone if different than above
8 Owner/Agent (if different than #1 above) f,-. —} j"'�
Ba. Hes/s Address
9 Zip
�/c�
< ! d --e) to
Cit
State
<lJ 0._
Phone
( )
15 Describe Work:
New /X Addition/Alteration ❑ Replace/Repair ❑
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(s):
Hood(s):
Duct(s)1: X
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: 1 b 4
40C-14
100-500M:
500-1000M:
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:
100,001 + BTU:
` C
18 TYPE FUEL SOURCE: Electric ; Gas ❑ ; 011 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat PumpRs,
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 72 APPLICATION
OWNER OR LJL•A-&-`—--o—C+_ DATE