1988, 02-02 Permit App 88000183 Furnacek
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLYTHOSE PARTS OFTHE FORM YOU UNDERSTAND
A -S
1
Owner's Name (Last) (oFirst) (M)
Department Use Only
Project No.
2
Project Address (Not Mailing Address) Space Zip
�. 800lr TRS/son/
3:
ty/Community
�a v�
State
Su lonl Plat Name
14AiW A\;,
4
Assessor Parcel No.
G�Si 2—�cloG
Lot -
Block
16
Can/actor Firm Name
Street Address
17
Zip
City)
��
Phone
18 Contact Person U nse_No. Phone if different than above
8 Owner/Agent(if different than Nl above) Business Address
9
Zip
City
State
phone
15
Describe Work: CD n�G �U 7—
�T New ❑ Addition/Alteration Replace/Repair ❑
10
Applicant Name
Street Address
11
Zip
City
State
Phone
8
VENT: Faris):
EVap Cooler(s):
Hood(s):
Duct(s)1:
Miscellaneous:
10
APPLIANCE:
Dryer(s):
Range(s):
Gas Log (a):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11
UNIT HEATER(S): Wall Mount: Y N
Floor: Y N
Suspended: Y N
12
AIRHANDLING: 10,000 CFM or less:
More than 10,000 CFM:
13
REFRIGSYSTEM BTU: 1-100M: ..
100-500M:
500-1000M:
14
1000-175OM:
Other:
Pressure Vessel (cu. ft.):
15
COMPRESSOR/HP: Less than 3: 3-15:
15-30:
3050:
50+:
16
GAS PIPING SYSTEM: Number of outlets:
17
///
HEATING SYSTEM: 1-100,000 BTU: / j � -91 GJ
100,001+BTU:
18
TYPE FUEL SOURCE: Electric ❑ Gas Oil ❑ Coal ❑ Wood ❑ Solar ❑
19
TYPE DISTRIBUTION: Forced Air ❑ Radiant ❑ 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 OF APPLICATION
OWNER OR DATE