1984, 12-13 Permit App: 00003707 DryerF
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name ILas
/1(Fiiir�st) , (� (M) Department Use Only
,�`,/'
t_ CJO I V `J m Project No.
2 Protect Address (Not Mailing Address) Space Zip
i 93ij FAWOrew , v 99,7/ a.
3 City/Community
(l /jam nV
State /�
Subdivision/ Plat Name
4 Assessor Parcel No.
Lot
I Block
16 Contractor Firm Name Ow NE!\
Street Address
17 Zip
City
Stale
Phone p,
(564, ) /en - ''(SD?
18 Contact Person
pr,.) A\JI`i f
License No.
Phone If different than above 1
8 Owner/Agent (if different than 41 above)
Business Address
9 Zip
City
State
Phone
)
15 Describe Work
New LY Addition/Alteration ❑ Replace/Repair 0
10 Applicant Name
0WYVE E
Street Address
11 .Zip
City
State
Phone
( )
8 VENT: Fan(s):
Evap Cooler(s).
Hood s):
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer(s). I
1 Range s):
Gas Log(s):
I Wood Stove/
Solid 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 Lp
15 COMPRESSOR/HP: Less than 3:
3-15:
15-30:
30-50:
50+;
16 GAS PIPING SYSTEM: Number of outlets: I
17 HEATING SYSTEM: 1-100,000 BTU:
180.001+BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas m'; Oil 0 ; Coal 0 ; Wood 0 : Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; 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 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
-d RAcio-e-
APPLICATION
DATE