1986, 10-24 Permit App 00013883 Gas Range Piping*
MECHANICAL PERMI APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ON_ LY THOSE PARTS OF THE FORM YOU UN STAND_
1 Owner's Name (Last (First) ] (M) . -
ti; � i/efh7/ IP !/ //VCGam_'
Department Use Only/���r}
Project No. �.�Jl`�7'i
2 Project Address (Not Mailing Address) " ':.... : -. Space . Zip
,J n6- TFiC•KSif)
3 City/Community
_ iro S-',4ti
State
� /9
Subdiv Ion/Plat Name
.= T� 1 1>�D
4 Assessor Parcel No.
075 2., -- e
Lot "-
Block
/C000 - A
16 Cofactor Firm Name _
f/2.0C i.Q0/f vR/IiA.0 _ _
Street Address
- 9.$i% - t'/.i
17 Zip
-9
City - -.
(/,w,4tiE
State
Gam,
Phone
(_ )9 8=��s
18 Contact Person
Liceme No.
Phone If different than above
It
8 Owner/Agent (If different than #1 above) .:
Business
Address ..,
9 Zip . .
City . ".
State , -.
-_
Phorie '
( )
15 Describe Work:
New -❑ - Addition/Alteration
-
0
Replace/Repalr 0
10 Applicant Name
Street
Address
11 Zip
City.
State ..
Phone
8 VENT: Fan(s):
E4apCooler(s):
Hood (s): -
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
Range s): X
Gas Log (s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNITHEATER(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. t.):
15 COMPRESSOR/HP: Lessthan3:
3.15:-
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets: 1
17 HEATING SYSTEM:1-100,000 BTU: - -
100,001 + BTU: ,
18 TYPE FUEL SOURCE: Electric . 0 ; " Gas ` ❑ ; Oil 0 ; ":. .` Coal ❑ ; Wood 0 ; Solar 0 .
19 TYPE DISTRIBUTION:. Forced Air 0 ; - Radiant 0 ; Heat Pump❑ ' • �
r."l > _ i, • Y-- 1 \l O/ t---.
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 fu - _ - -t I pro-
visions of laws and ordinances governing this type of work, including inspectp Eacie , wit .e com-
plied with whether specified herein or not. The granting of a permit does not resume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction. ALLIENDORF.FURNACE
A DiiViSaO OF ALLI %EATING INC
SIGNATURE OF `
OWNER OR E. 931 THE"h1T AVE.
a•it'uhru nie. St28-8252
Utj i 2'c
APPLICATION
DATE i/may/��