1987, 06-01 Permit App: 87001648 Air HandlerMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
r—n l L 23;33k3 L -S
240
1 Owner's Name (Last) (First) _ (M)
leis
Department Use Only /e,/i—t!4/c-/
,L
LEL, GrLL,
Protect No.
2 Project Address (Not Mailing Address) Space Zip
E . /7 4'0/ 460 0 .t'
3 City/Community
/
State
/
Su/
bbddiviision/Plat Name
�y�
' �//7-
Z(1/9
n/
4 Assessor P cel No.
/‘51/2- -053 f
Lot
I Block
16 Contraclg9Firm Name
Street Address
ti f3.p M152;CC4.t2.
74% ,%% ,V 4L-77.-----7,--1 o
17 Zip
X99 7
City
c`�o,e,1-,x/E
State
�/�
Phone
( ) 52' -� 7f
Phone If different than above
18 Contact 'erso
.
License No.
1 de
61
351(49
8 Owner/Agent (if different than 41 above)
Business Address
g Zip
City
State
Phone
1 )
15 ribe Work: /,� ff�� L7 I
�K y"/it 7 iA New 0 Addltion/A
7
teration LL / Replace/ Repair 0
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):
1 Range s):
Gas Log(s):
1 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 10W -1750M:
Other:
Pressure Vessel (cu. t.):
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: g3"—i__..100,001
•
+ BTU:
18 TYPE FUEL SOURCE: Electric 0 Gas C4 -r— 011 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Alr "...ir'''''''..----Radlant 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
OWNER OR
APPLICATION
DATE