1984, 09-10 Permit App: 00002248 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 (Last) (First) (M)
att---t
Department Use Only
Project No.
2 Project Adess (Not Mailing Address) ,� Space Zip
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3 City/Community
J
StateII� 11
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Subdivision/Plat Name
4 Assessor Parce =
Lot 1 Block
16 Contractor Firm Name
C CO )..,,._ dJ4---.),-54.4%--.../k t 1t.. � c -
Street Address
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17 Zip
iY aLe Co •
City
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tate
Phone
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18 Contact Person
nse
I6Er
%1)(7%�No.
Phone if different than above
8 Owner/Aeent
J',U`�
(If different than 01 above)
Vtil
1..Qi WA.. -
Busi
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ss Address y
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9 Zip C� /
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):
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): Wali Mount: Y N
Floo : 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: Less than 3:
3-15:
15-30:
30-50:
50+: ,
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
•
18 TYPE FUEL SOURCE: Electric Gas 0 ; 011 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 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 OR
APPLICATION
DATE '- / -7-