1985, 05-10 Permit App: 00005363 Furnace, Piping 1 -
MECHANICAL PERMIT APPLICATION WORKSHEET 2. Ct96)
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
AAS
1 Owner's Name (ILas t ( it t) / (M) Department Use Only
(Notj'1 r/ i, (J ,�_-1'r' t Project No.
2 Project Address Ag
Addr Space Zip
/..,i_,
3 City/Co nity > State ' Subdivis)errltPlat Name
4 Assessor P cel No. Lot Block
/65i/2 - �?93S ' 7 j_'=
16 Co actor Fir N Street Address
1 Ai 61_ ,u4--I ily ii- ra--
17 ip �,�� C f� State Phone r
18 Contac PersonLicense No. Phone if different than above
V ICreskI /4mie tfg — )53 Al/
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
y/ ( )
15 Describe Work: _ A s�- ,�1 4 :" ,-'1� 4.1-t1
New ❑ Addition/Alteration ❑ " Replace/Repair
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: Wood Stove/
Dryer(s): Range(s): Gas Log(s): I Solid Fuel: Gas Water Heater(s):
Z 11 UNITHEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
W
a12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
0
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
tl
O
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a
>-
I-
0
-
I—
O 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
Z
Q
CO 16 GAS PIPING SYSTEM:Number of outlets: / 1! 1 ) / Vim
4/17k
Z QV
17 HEATING SYSTEM:1-100,O1�Y@TH� ��&'�� �� 100,001+ BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas 14; Oil 0 ; Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air 'Iil;f; 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 APPLICATION
OWNER OR )14117:& DATE
�L' .