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1984, 12-06 Permit App: 00003703 Water Heater* 1- z w 2 a 5 0 w LL 0 w a >- H cr0 z w m i z MECHANICAL PERMIT APPLICATION WORKSHEET /.31k'C 4 PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name Last (First) (M) Department Use Only / i 044Q / Project No.—+ 2 Project Address (Not Mailing Address) y r Space 64-7.4-)^� - n �% Zip _Ad/ Lt-tak.- iy�ri l9li':� i�iwsiG�T/� Cx /v J `w 3 City/Community State Subdivision/Plat Name WA/Li k/a/k-- AC 4ivt I;)� 4 Assessor Parcel No. Lot Block y 16 Contractor Firm Name 2A4--- -- (V-I.C2-e.---/\--CL____ Street Address '----. o, & • f,`7o 7 17 Zip 99Z City 6 -Aa./- State �es Phone ( )-„rGf 18 Contact Person License No. Phone if different than above 8 Owner/Agent (if different than #1 above) Business Address 9 Zip City State Phone ( 1 15 Describe Work: New ❑ Addition/Alteration ❑ Replace/ Repair ❑ 10 Applicant Name /� e Ce} -1/-Y —�— - Street Address /0 / �, / 11 Zip c192fo City g a StatePhone G��-- ( ) 97_4, 53a--- 8 VENT: Fanis): Evap Cooler(s): Hood(s): Duct(s) 1: Miscellaneous: 10 APPLIANCE: Dryer(s): 1 Range s): Gas Log(s): Wood Stove/ Solid Fuel: / L/1 -l-- Gas Water Heater(s): //6 II 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: 17 HEATING SYSTEM: 1-100,000 BTU: 100,001 + BTU: 18 TYPE FUEL SOURCE: Electric 0 ; Gas 0 ; Oil 0 ; Coal 0 ; Wood 0 ; Solar ❑ 19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat Pump I=1 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