HomeMy WebLinkAbout1985, 05-07 Permit App: 00005361 Gas Piping*
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MECHANICAL PERMIT APPLICATION WORKSHEET /Z Oa
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Lastl (First) dM)
Department Use Only
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Project No.
_I
2 Project Address (Not Mailing Address) G "L Space Zip
/1 7,-) .5 (-7 —!-1C t��
3 City/ .mmunity
State
Subdivision/Plat Name
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4 As- :sor Parcel No.
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Lot
Block
ifl
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16 Contr ctor Firm Name
.tet/�/2',(t'f: r' �.
Street Address
• /600 7' -e /..;z,
17 Zi p
Cit
State
Phone
18 Comet ct Person
0✓a....e,c11 .fuel -c lL„.<,
License No.
/4-/e 097- T /-- / 9I G N
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
I Phone
( )
15 Describe Work:
New ❑ Addition/Alteration ❑ Replace/Repair ❑
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(s):
Hood s):
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
Range s):
Gas Log (s):
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 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: l
17 HEATING SYSTEM: 1-100,000 BTU: 1 100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas Oil ❑ ; Coal ❑ ; Wood 0 ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; 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 S' 7