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1985, 08-20 Permit App: 00007106 Furnace . MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name (Last) ?jilt) J.M) Department Us Opl C A-,�C J Project No. /Old 2 Project Address(Not Mailing Address)j. Space Zip ',/ i,? 9'�—. 9737 3 City/Co,munit ' State ) Subdivision/Plat Name i �_1 ^_.Cle- —e---- a/'(-' (l/2_%4 C 1(e S oti t3 p i :./ t >'c 4 A s' sor Parcel No. Lot Block 0.s )(, «_ 16 Contractor irmame 1 Str t Address 17 Zip City State Phone rjet i o1 S/'d > ) u) (-f-7-1 ) ‘9.---,3V— jT., _ 18 Cont Per on License No. Phone if different than above ..s, 1 8 Owner/Agent(if different an#1 above) Business Address 9 Zip City State Phone ( ) 15 Describe Work: 1 New ❑ Addition/Alteration ❑ Replace/Repair ❑ 10 Applicant Name Street Address 11 Zip City State Phone ( ) r : * 8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous: 10 APPLIANCE: Wood Stove/ • I Dryer(s): Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s): I—; 11 UNIT HEATER(S): Wall Mount: V N Floor: Y N Suspended: Y N Z; W. aa. 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM: 0� 0 W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M: U- 0 W 14 1000-1750M: Other: Pressure Vessel(cu.ft.): Ct. >I— ® 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+: Z Q W 16 GAS PIPING SYSTEM:Number of outlets: M 2 Z 17 HEATING SYSTEM:1-100,000 BTU: , //''46.../�j/ 100,001+ BTU: 18 TYPE FUEL SOURCE: Electric ❑ ; Gas /I - Oil (❑ ;; Coal ❑ ; Wood ❑ ; Solar ❑ 19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; Heat Pump CI 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 OF01 / 21, APPLICATION — OWNER OR %" I / " ( -z'� %fit DATE � /