1985, 06-13 Permit App: 00005992 Mechanical Fixtures1-
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MECHANICAL PERMIT APPLICATION WORKSHEET . 5e
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name /] �L(Last) (First) _/ ( / (M)
///k Z -S0."/ /77,L.,Y0F1/ _
Department Use Only
Project No. .
2 Protect Address (Not Mailing Address) /� Space - Zip
44 // / �/; 4,/,/6/V Ai Z'_ 9 9.2 /6--.
3 City/Community
l//
Stateat/.,�Stier
Subdivision/ Plat Name
4 Assessor Parcel N -
i`> 43- gee' 2-'
Lot
Block
'
59x2
16 Contractor Firm Name
16
5—
, ,.2 -,4,:2- s o
Street Add ess
/ 4/// ///7 v/2X--*9
17 Zip
2 0 2
City,State
o%4/2t
i'oos/f,
Phone
( ) L5 -..7V-75-.9-/
18 Contact Person License No.
�cc� / 90 a
Phone if different than above
8 wnerl Agent Of different than tl above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work
New t'' Addition/Alteration E Replace/Repair 0
10 Applicant Name -
Street Address
11 Zip
City
State
Phone
1 )
8 VENT: Fan(s):
Evap Cooler(s);
Hood s)
Duct(s) 1.
Miscellaneous
10 APPLIANCE:
Dryer(sp
Range s)
Gas Log(s):
Wood Stove/
Sol Id 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 10,000CFM. -
13 REFRIG SYSTEM BTU: 1-100M:
100-500M.
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. t.)'
15 COMPRESSOR/HP: Less than 3:
3-15:
15-30:
30-50:
50+:
16- GAS PIPING SYSTEM. Number of outlets:
17 HEATING SYSTEM:1-t00,00013TU' 100,001+BTU.
,4t4,/Vt4✓3/9L 1 Tip.✓rC
18 TYPE FUEL SOURCE: Electric D ; Gas V; 011 0 , Coal ❑ , Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant 0 ; Heat Pump
1* Number of separate zones for any heating, A/C or aft 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 OFlJ APPLICATION /st--
OWNER OR U� �2�r — DATE
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