1985, 02-17 Permit App: 00004264 Furnace1-
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (M)
Department Use Only 4
L / s
-�:
�q(First)
SC yoE-,i, V /�.
Project No.
2 Project Address (Not Mailing Address) Space Zip
E: //7/o M y 4 .,zo
3 City/Community
S'/'aX/P/ie
State
w /
Subdivision/Plat Name
�q%J J w W6j
4 Assessor Parcel
No.
Lot
Block
16 Contractor Firm Name
11N06esoA) 's frc; . Aim co.vD ./3Io
Street Address
3 i ti..a %- .
17 Zip
?f ,2 -/C-.
City
..-.:;,0 KAhs6-
State
Ci../AJ -
Phone
(5o?) %28 -- 0 96 0
18 Contact Person
0-4 l c rt Al ,,e so,rii
License No.
f, AIDER C//
P I3 Af
Phone if different than above
8 Owner/Agent (if different than M1 above)
Business
Address
g Zip
City
State
Phone
(
15 Describe Work:
New ❑ Addition/Alteration
E
Replace/Repair fl
10 Applicant Name
Schioe. 1 V ./n.
Street
es.
Address
//9/o - q /91/44.--
11 Zip
9 o.6
City
srok4,v6-
State
w11-
Phone
(-6-0?) 7?9 -.5'750
8 VENT: Fan(s):
Evap Cooler(s):
Hood(s): 1
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:I
Dryer(s): 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: 2
17 HEATING SYSTEM: 1-100,000 BTU: 0/ C -c,) ark
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric fl ; Gas q'' ; Oil ❑ ; Coal 7 ; Wood Solar [Ti
19 TYPE DISTRIBUTION: Forced Air pr. ; Radiant ❑ ; Heat Pump El
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 7/u.
APPLICATION
DATE
,A}iv06eSoAJ 's 17e�T/4 6 g' / f/ e0,00.
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