1985, 10-05 Permit App: 00007850 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 ) t)
ei: t) (M)
Department Use Only ._ Lry
- L
1 i l 7 W[t,i ..-c_
Project No. ,3
2 Project Address (Not Mailing Address) Space Zip
' • 4 0� �. %u ..ba -ex-- 7 t:2
it/
3 City/Comm
Stat
Subdivision/Plat Name
4 Assessor P cel No.
17ffq& "D4Otb
Lot
Block
16 Contr tor Firm Name
Street/Address \yZNLL
4;27, 1)
cr
��ity
17 Zip
State
Phone
18 Contactt rt
--e
1
&.t '
License No.
i /I 101; a - 9 3
Phone if different than above
8 Owner/ Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
I
15 Describe Work:
New 7 Addition/Alteration E Replace/Repair --
10 Applicant Name
10
Street Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
Evap Cooler(s):
Hood(s): [Duct(s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I Range s):
Gas Log(s):
I 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 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: / / - .) / j / r J ~ /� C^-
17 HEATING SYSTEM: 1-100,000 BTU: 7 L
7�l r!O v+ � ' �C ,• -4'i
100,001 + BTU: C
. if.Li`Wtdc-Cl
18 TYPE FUEL SOURCE: Electric — Gas 0.4; Oil 0 ; Coal 7 ; Wood 7 ; t;' Solar 0
19 TYPE DISTRIBUTION: Forced Alr i., ; Radiant 0 ; Heat Pump ED
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 yfri 7 ,,APPLICATION
OWNER OR CSZ ,� DATE (