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1987, 03-27 Permit App: 87000818 Furnace, Piping • i 1� MECHANICAL PERMIT APPLICATION WORKSHEET ' '� ,� PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 81 y las SFR 1 Owner's Name (Last)_ (First) (M) Department Use Only 40-S� r/qA" - y Project No. �-8Ie 2 Project Address(Not Mailing Address) � t ,oace Zip 9 /G/7 T 3 City/ mmunity State I Subdivision/Plat Name 4 Assessor Parcel No. Lot Block 265443 -1512. ig___ ,S` 16 Con tor Firm Name Street ddress -- . 17 Zip City State Phone 18 Contact Person / License No. Phone if different than above B Owner/Agent(if different than M1 above) I Business Address 1 9 Zip City State Phone ( ) 15 Describe Work: New 0 Addition/Alteration 0 Replace/Repair 0 10 Applicant Name Street Address 1 11 Zip City State Phone ( ) * , * 8 VENT: Fan(s): E4ap Cooler(s): Hood(s): Duct(s)1: Miscellaneous: 10 APPLIANCE: Wood Stove/ Dryer(s): 1 Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s): • Z' 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N W d 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM: 0 a W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M: LL o. W 14 1000-1750M: Other: Pressure Vessel(cu.ft.): a >- I— O 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: I 30-50: 50+: Z WNumber o 16 GAS PIPING SYSTEM:Numbf outlets: (f) ,z5-4.2 4 m O• 17 HEATING SYSTEM:1-100,000 BTU: 7 --------- 100,001+ BTU: Z 18 TYPE FUEL SOURCE: Electric 0 ; Gas 0 ; OII 0 ; Coal 0 ; Wood 0 ; Solar 0 19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat Pump 0 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. r SIGNATURE OF EriAPPLICATION /, OWNER OR Ei ) �,eft. DATE ` �` / �� � f fif7- 2 - / r91