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1984, 12-28 Permit App: 00003818 Furnace • .. MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND y- 1 Owner's Namee/ (Last *first) �4 dvl)� Department Use Only Lel ./ . o. t 2 Project A dress(Not Mailing Address Space Zip 10• /2/9 w� �7 3 mm ity State ',G',�,/.C� Subdivision/Plat Name 4 ssessor Parcel No. Lot L=/V' Block 16 Co tr for F'rm Name j/`� ' e/e/) Streetges / 1 Zip Ci State Phone 18 Contact Person License No. Phone if different than above 8 Owner ent(if different tha #1 above) BusinessAdd s Z- �/ _ GTS /_.., ? ��ES /� 9 Z �j� City State Wei'l . 27Ph'f.,t'kg-- I /� Phone Q? '/ 9 76-• 699) 15 Describe Work: New ❑ Addition/Alteration 0 Replace/RepairX 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): I Range(s): Gas Log(s): I Solid Fuel: Gas Water Heater(s): Z 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N W 2 a 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM: 5 a W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M: LL 0 W 14 1000-1750M: Other: Pressure Vessel(cu.ft.): d >- I— O 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+: Z Q W 16 GAS PIPING SYSTEM:Number of outlets: / GO Z —. ��b00 Tit D 17 HEATING SYSTEM:1-100,000 BTU: ��` 100,001+ BTU: 18 TYPE FUEL SOURCE: Electric ❑ ; Gas/ ///,P‹; Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑ 19 TYPE DISTRIBUTION: Forced Air X'; Radiant 0 ; Heat Pump ID 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. SIGNATURE07‘;:---1 APPL ICATIO OWNER OR ' %% ..4 4c......; a DATE v^�`� ��