1985, 04-18 Permit App: 00005021 ACMECHANICAL PERMIT APPLICATION WORKSHEET 7/S
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Nam Last rs (M)Department
Use Only
>��
Project No
2 Project dress(No Mailing A.dress) $pace. '/p
Cit mmunity
3f9C1(r
State
�%�
Subdi n/Plat Name
UrchE,«/ Ave, Ade/
4 A essor Parcel No.
06154 — VikR
Lot
Block
QV
5021
16 Con ra or Fir Name '/G, / A�
C/ -J �/ y�
Sir Addr_e�s
/ �c)/
17 Zip
CI
State State
Ph`�o�ne%j.
18 Contact Person
'cense
�j �%/�J/-� No
Phone if different than above
8 Owner/Agent (if different than e1 above)
Business Address
9 Zip
City
State
Phone
15 Describe Work.
Addltion/Ateration Aell Replace/Repair ❑
10 Applicant Name
Street Address
11 Zip
City
State
Phone
l I
8 VENT: Fan(s):
Evap Cooler (s)•
Hood(s)
Duct(s) 1.
Miscellaneous:
10 APPLIANCE'
Dryer(s).
I Range s):
Geo Log(s).
Wood Stove/
Solid Fuel'
Gas Water Heater(s):
11 UNIT HEATER(S): Wall Mount: Y N
I Floor Y N
Suspended: Y N
12 AIR HANDLING' 10,000 CFM or less:
More than 10,000CFM•
�J'/���jjj///fff
13 REFRIG SYSTEM BTU: 1-100M' `'7 ,�`(' 100-500M'
500-1000M:
Pressure Vessel (cu. t )'
tg
14 1000-1750M: frilitOther.
15 COMPRESSOR/HP: Less than 3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM' Number of outlets.
17 HEATING SYSTEM: 1-100,000 BTU /j /�^ / to100,001
+ BTU:
18 TYPE FUEL SOURCE: Electric 0 , Gaaas Oil 0 ; Coal 0 ; Wood 0 , Solar 0
/
19 TYPE DISTRIBUTION. Forced Air ; Radiant 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 corn -
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 0
OWNER OR
APPLICATION r.808_,
DATE