1984, 10-12 Permit App: 00002924 Furnace -
MECHANICAL PERMIT APPLICATION WORKSHEET
' PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) I'j (M) Department Use Only
enl Project No.
2 Project Address(Not Mailing Address) Space Zip
6. //3v7`/ 1q,f17 '/ �;7fl'i s,�J(.I� `rc2 i. 1:•-e
3 City/Community State Subdivision/PlatyName
PcX� /SC
/IE G✓67 J i_c;/tit/ --TectiN5;/c
4 Assessor Parcel No. 1 Lot Block
/1.7_Ff4/7 ii/e6 !" V
16 Contractor Firm Name Street Address
/-/E 7- rEic // / 7�ovr6"d/»E,(-�`Y
17 Zip City State Phone
a a C 51'd1r-,9x/6- (5 ) %.;.?6 --/('5'3
18 Contact Person License No. Phone if different than above
Prelei 6".9
8 Owner/Agent(if different than 41 above) Business Address
9 Zip City State Phone
( )
15 Describe Work:
New 0 Addition/Alteration 0 Replace/Repair 0
10 Applicant Name Street Address
11 Zip City State Phone
*
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
10 APPLIANCE: I Wood Stove/
Dryer(s): I Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
F- 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
W
2
a 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
O
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
LL
O
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
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O 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
w 16 GAS PIPING SYSTEM:Number of outlets:
fn
2
Z 17 HEATING SYSTEM:1-100,000 BTU: pc...), 6 6J .3 7- 100,001+ BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas ')e,/ Oil 0 ; Coal 0 ; Wood ❑ ; Solar 0
19 TYPE DISTRIBUTION: Forced Air CLZ; Radiant ❑ ; Heat Pump❑
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 t /( APPLICATION
OWNER OR ,/4--= '�-'�✓ — DATE /6--/ —