1986, 11-14 Permit App 00014154 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
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
—. Project No. 415
2 Project Address (Not Mailing Ad ) - Space Zip
579- & J V . i1°�.)
3 City/Commuunijty
State y,
Subdivision/Plat Name
4 Assessor Parce No.
Lot
Block
16 Contra it Nam ._._
i �. VI Gam, �.I-4� %ie
Street Address
ii 0 C�� 1.../—
17 Zip
9. ,EaS
City
..,'
State
itcn
Phone '
( )3 Gil
18 Contact/P� n
Lic nse No.
-
Phone if different than above
8 Owner/Agent different than ff1 above)
.Business Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New Addition/Alteration 0 Replace/Repair ❑
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. ft.):
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: %/ `Ge/ ! �Ll
it ld-
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric g; Gas 0 ; Oil 0 ; Coal 0 ; Wood ❑ ; Solar 0
19 TYPE DISTRIBUTION: Forced Air Radiant 0 ; 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 .1
OWNER OR /1
APPLICATION /
DATE /l/ / L,