1985, 11-01 Permit App 00008453 Furnacew
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) n (First) r (M)
Department Use Only O . -77
J--t�CC k 4 SL
Project No. / 1fi
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Addr s) . Space Zip
2 Proj dress (Not Qv/
C', /D Qv/ co-e—c -6_ C' C
3 City/Community
State
Subdivision/Plat Name
4 Assessor Parcel o.
Lot
Block
16 Contr Firm Name ^ �
--L F..R--'
StrgGt;Addresss
r' - j • /1 - .
17 Zip
i`? .Le
City
State
(��`�
Phone
( ) j -0P)._5 i
18 Contact Person
License No.
Phone If different than above
MU
8 Owner/Ag t (if different than #1 above) I Business
(-42.-. ,--:_jt-Z.. " I
Address
9 Zip Y 7 V
ish-V--4.1
City
State
Phone
15 Describe Work: , `
New L4 Addition/Alteration 0
// �\
Replace/Repair 0
10 Applicant Name
r‘
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(s):
Hood (s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
Range s):
Gas Log(s):
I Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(S): Wall Mount: Y N
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: Less than 3: 13-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU: 5/ / �
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric Gas 0 ; Oil 0 ; Coal 0 Wood 0 Solar 0
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19 TYPE DISTRIBUTION: Forced Air V 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.
ALDENDORF FURNACE
SIGNATURE OF A DIVISION OF ALLIED HEATING. itiC- APPLICATION
OWNER OR f- 9311 'r ='IkT AVE. DATE /o - 0PS
SEE, WA 99206
92