1984, 09-21 Permit App: 00002578 Furnace, ACz
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Cxmar's Name (Last)(First) (M) Department Use Only
Project No.
2 Prooct Address (Not Mailing Address) Space Zip
3 Cty/Community
State
Subdivision/Plat Name
r1 t / AvC 44/
,„1-=-
4 Assessor Parcel No.
Lot
Block
1
-1605-- ,.0213-7
16 Contractor Firm Name
Street Address '9—e
f 41.1-k-
1.1-/
17
17. Zip"
City
State
Phone
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18ContactPerson
Lcense No.
Phone if different than above
8 Owner/Agent (if different than M1 above)
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Business
Address
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1 Phone
15 Describe Work:w
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• 10 Applicant Name
Street
Address
11 Zip
City
State
Phone
(. )
8 VENT: , Fan(s):
Evap Cooler(s):
Hood
s):
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer(s): 1
Range's):
Gas Log (s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
1 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:
3 '3EFRIG SYSTEM BTU.. 1-100M: t.
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. ft.):
15 COMPRESSOR/HP: Less than 3:
3-15:
15-30:
30-50:
50+;
1K r;dC PIP1Nr CYCTFh_S•'.4 Imhar nf' Iets' ...
HEATING SYSTEM: 1-100,000 BTU
100,001 + BTU:
F._..17
18 TYPE FUEL SOURCE: Electric El ; Gas -❑ ; 011 ❑; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air '0 ; Radiant 0 ; Heat Pump❑,
1* Number of separate zones for any. heating, A/C or air handling system.
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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 APPLICATION
OWNER OR ` DATE'