1985, 06-05 Permit App: 00005762 Furnace•
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name ,(f�rst�) �Ay, Department Use Only
�(L¢ste
le (I 1/ �K✓ Project No.
2 Project Address (Not Mailing Address) Space Zip
Al
N. l{0 /C(et-9'' M
3 City/Community
eX
I Stat
Subdivision/Plat Name
4 Assessor rcel No.
/` 5t .l /
Lot
Block I
5-7&2_
Con actor Fir Nam Sreet !L7 f4- - DI e Itth77,oi�, 0/A►U4
-
17 Zip
Cly.
State"
Phone
18 Contact person
License No.
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business
Address
g Zip
City
State
Phone
( )
15 Describe Work:
New ❑ AddltionlAlteration
❑ _
R placc e,
e ,e
air vw�C
air
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):
I Range s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNITHEATER(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. ft.):
15 COMPRESSOR/HP: Lessthan3:
3-15:
15-30:
30-50:
50+:
/16 GAS PIPING SYSTEM: Number of outlets: /] f/ / � //
17 HEATING SYSTEM: 1-,11BTLC ) AAA i x_ja
s
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas/ ; 011 ❑ ; Coal ❑ ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air)14,4 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
OWNER AOR
APPLICATION
DATE