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1988, 01-12 Permit App: 88000060 Furnace, Piping i ,. :r x` ,��````�* 'ma MECHANICAL PERMIT APPLICATION WORKSHEET I PLEASE PRINT AND COMPLETE ONLy.THOSE PARTS,OF.THE FORM YOU UNDERSTAND 1 Owner's Name (Last) . (First)/� (M) Department Use Only I Name , 4 L 4 i 4T/e,/7i `Project No. 13>`S-ts,23 2 Project Address(Not Mailing Address) �.�,, -.Space Zip .: 3 City/Community State _ Subdivision/Plat Name // r 4 Assessor Parcel No. Lot Block 16 Contractor Firm Name Street Address A �� �4,-..� l-e 2-�,cte` ▪ -: , SIV/i. / 17 Zip CState Phone T a 4' YJ � -e._ //21-`-- . ( . ) 9, e----89, e----8: -,,,2_18 Contact Person /LicenseN�. Phone If different than above 8 Owner/Agent(If different than#1 above) I• Business Address 9 Zip City State Phone • 15 Describe Work: New XI - Addition/Alteration ❑ Replace/Repair. 0 10 Applicant Name -— Street Address 11 Zip City State _i s Phone * * 8 VENT: Fan(s): Evap Cooler(s): Hood(s): ", Duct(s)1: Miscellaneous: 10 APPLIANCE: I Wood Stove/ Dryer(s): Range(s): - Gas Log(s): Solid Fuel: Gas Water Heater(s): F— 11 UNIT HEATER(S): Wall Mount: Y N Floor: V N Suspended: Y N Z W a 12 AIR HANDLING: .`10,000 CFM or less: More than 10,000 CFM: 0 W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:. W O W 14 1000-1750M: Other: Pressure Vessel(cu.ft.): Q. O 15 COMPRESSOR/HP: Lessthan3: 3-15: - 15-30: 30-50: 50+: Z Q \ u1� 16 GAS PIPING SYSTEM:Number of outlets: / (1; _-_.'21 ' b m 1 O 17 HEATING SYSTEM:1-100,000 BTU: I 1 J 100,001+BTU: ,. Z 18 TYPE FUEL SOURCE: Electric 0 ; Gas >4 Oil 0 ; Coal ❑ Wood 0 ; Solar 0 19 TYPE DISTRIBUTION: Forced Alr 0 ; Radiant 0 ; Heat Pump 1* Number of separate zones for any heating, A/C or air handling system. I certify that the above in orrnation 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 �. DATE / /a Sy 1 v 7Vy-r-;'1 I'