1985, 08-14 Permit App: 00007149 Furnace • Pro
MECHANICAL PERMIT APPLICATION WORKSHEET
As
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (Firs)� (M) Department Use Only �i,��
//z�r- i 'i< )`, L� Project No. -�
2 Project Address(Not Mailing Address) Space Zip
t n51"/y� — - 9:7):::/Z---
3
f, `
3 i"ttyy/Community State Subdivision/Plat Name
4 Assessor Parcel No. I Lot I Block
16 Contractor Firm Name _ Street Address
17 Zip City State Phone
99 ,:l 'V&A-4,A.- , ` . C_5;219) -5__3 / 7
18 Contact Person License No. Phone if different than above
d it 9/7/‘777.494'-)-b90/ /c/V /1„4'1`- i 7
ll /V
8 Owner/Agent(if different than#1 a Business Address
9 Zip City State Phone
( )
15 Describe Work: /'/L F2/./.. c"," &# .:-,
/ � _ New ❑ Addition/Alteration ElReplace/Repair
10 Applicant Name Street Address
11 Zip City State Phone
( )
* *
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
i
10 APPLIANCE: Wood Stove/
Dryer(s): I 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
2
eL 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
0
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
LL
0
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
CL>-
I—
C) 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
Z
Q
W 16 GAS PIPING SYSTEM:Number of outlets:
CO
17 HEATING SYSTEM:1-100,000 BTU: �, . -./-, ''T? 7.4..‘.7.„/
�+ 100,001+ BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; Oil >(;/
Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air ; Radiant ❑ ; Heat Pump❑
Pany heating, handling system. c"
1* Number of separate zones for A/C or air ' �'
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 � r APPLICATION
OWNER OR /,->-13,‘,- ,', /&..�: