1987, 11-13 Permit App: 87003924 Furnace1-
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MECHANICAL PERMIT APPLICATION WORKSHEET '�'`�' ��
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FOF M YOU UNDERSTAND
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1 Owner's Name (Last)______,(First) ----�-, (M)
4/N.DV5gW6 ,// 4 Ili A/
Department Use Only
Project No. _ L
2 Project Address (Not Mailing Address) Space Z .
//6D6— 1 tie .s/.4_
3 City/Community
D�N e_
f),C/A
State
LO�
Subdivi��laame
PP
4 Assessor Parcel No.Lot
� / 0544 __
l(o57/1/—
Block
11n
16 Co tt Firm Name
Ge'i>22`G GCiLxCZC 2_--
Street Address
c__6�/ eye
17 Zlp
City
State
Phone
18 Contact Person
License No.
Phone if different than above
8 Owner/Agent (If different than #1 above)
I Business
Address
9 Zip
City
State
Phone
( )
15 Describe Work: ({/4iv6 DUT /4 TD 6 ,i 57/ z2S �` ><- /5" T/A/C
New 0 Addit on/Alteration X
U(,)d-r
Replace/Repair 0
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(a):
Hood(e):
Duct(s)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 Tess:
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: C/� 6C:)
G
17 HEATING SYSTEM: 1-100,000 BTU: Cl 1 Y, Gi
/
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas X ; OII 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
OWNER OR ,r DATE /�kVg:7
APPLICATION