1985, 11-18 Permit App: 00008773 Furnace+r • MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name 0 (Last) (First) (M)
Department Use Only
`(0 Iaie r$KL�
Project No. 773
2 Project Address (Not Mailing Address) Space Zip
6 tier t'fr ' y way
3 CIty/Community
State
Subdivision/Plat Name
4 Assessor Parcel No.
Lot
I Block
18 Contractor Firm Name
"47.48C -e k. ar
Street Address
/9 rn."-
17 Zlp
f�C
Clty
/—
State
1.611
Phone
( ir® ) rzer'r,
18 Contact Person
I License No, G�^[�.�C
`/
Phone If different than above
8 Owner/Agent Of different than lfl above)
Business
Address
g Zip
City
State
Phone
( )
15 Describe Work:
New ❑ Addition/Alteration
0
Replace/Repair A
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
1 )
8 VENT: Fan(s):
Evap Cooler(s):
Hood ):
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. t.):
15 COMPRESSOR/HP: Less than 3:
3-15:
15-30:
30-50:
50+:
18 GAS PIPING SYSTEM: Number of outlets: 1
17 HEATING SYSTEM: 1-100,000 BTU: /
100,001 + BTU:
////
18 TYPE FUEL SOURCE: Electric 0 ; Gas 1 ; on❑ ; Coa ❑ ; Wood 0 ; Solar 0
//
X19 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 7� �i /�/Gja _ ADAPPTLEICATION #1 /f er
OWNER OR 40144,044.4. jam'