1985, 08-28 Permit App 00007370 FurnaceAc
MECHANICAL PERMIT APPLICATION WORKSHEETG'. c�
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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1 Owner's Name (Last) (First) (M)
Department Use Only
,�,� % AG- —
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Project No. -�J
7-1-(22
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Project Address (Not Mailing Address) Space Zip
. %lC5/7 r`� - ev u-)- -. 6
3 Cit /Community
f d /,� N c'
Stated
l�C/A
Subdivision/Plat Name
t�S�z'- t N 4 0,0 -cc, 6 `-' A C SC
4 Assessor Parcel No.
t 5C( - t 1 10
Lot
Block
16 a. tractor Firm Name
Street Address
17 Zip O
dap
City/ 1
-'-
State
Gl�c�--
Phone
(.-?i) T3.5--733
18 Contact Person 7
,Licceenn �jnse No.
Phone if different than above
8 Owner/Agent (if different tha .1 -bove)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New ❑ Addition/Alteration ❑ 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:
Dryer(s):
I Range s):
Gas Log (s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNITHEATER(S): Wall Mount: Y N
I Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or less:
More than 10,000 CFM:
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. t.):
15 COMPRESSOR/HP: Lessthan3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets: /_
17 HEATING SYSTEM: 1-100,000 BTU: /\ �/
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas X; Oil 0 ; Coal ❑ ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat Pump El
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 Cif ' APPLICATION
OWN -ER —OR .._.Gi' C�i1�i�-�i��-� DATE