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1985, 09-06 Permit App: 00007494 Furnacew 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 �z//; S Q 4/ i oI c/ `� Project No. C ii 2 Project Address (Not Mailing Addr s) Space Zip / o 9'9aea 3 Gilt �unity /4/14 Irk State‘Subdivi al /Plat Name n uReffircp 4 Assessor Parcel No. /j 0&5 — 2.am21 Lot I Block 16 Cor/l i Xai' me V7t / 4`t�rvt Address— �2 17 Zip + JCity_�1W �� p��f v StateGd Phone 9) ?7 18 Cont son License No. Phone If different than above 8 wn /Agent (if fferent t an 91 ve) Business Address g Zip City State Phone ( ) 15 Describe Work: New ❑ Addition/Alteration 0 Replace/Repair 0 10 Applicant Name Street Address 11 Zip City State Phone ( ) 8 VENT: Fan(s): Evap Cooler(s): Hood(s): Ducts) 1: Miscellaneous: 10 APPLIANCE: Dryer(s): I 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: 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: / I ) „ J �� i / 17 HEATING SYSTEM: 1-100,000 BTU: /-"© a d 100,001 + BTU: 18 TYPE FUEL SOURCE: Electric 0 ; Gas 0 ; 011 0 ; 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. 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 1 OWNER 0 5 APPLICATION DATE / v/