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1984, 10-10 Permit App: 00002758 Mechanical Fixtures1- 5 - z W a_ 5 W LL 0 W 0 1- 0 z cc 00 z MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name (Last) ,(First) (M) C ©©`< 8/C4 u X G� Department Use Only /' Project No. 2 Project Address (Not Mailing Address) , Space Zip ( //' ;S— 213 �Q/if f> i a Ce," 7. Z 7 _ 3 City/Community 5/'0Au/7e State 1,,t,/t_r Subdivision /Plat Name uth/6 f �% Y-14 4 Assessor Parcel No. C3 U -' O40b Lot 1 �_._ I Block `� 16 tracr FI ame � Qt /;, //,? Street Address F /27/o .2 7 ,z -i9/ /, _1 17 Zip / City 97Z Ir 15Po/4"a/i _ State 6L Phone (rag ) 92? -2 (CO 18 Contact Person ti: .i' `. License No. '3/ ;/j-l3Z3BC Phone if different than above 8 Owner/Agent (if different than M1 above) Business Address 9 Zip City State Phone ( ) 15 Describe Work: New ❑ Addition/Alteration ❑ Replace/Repair 0 10 Applicant Name RtChu`4 c00A. Street I Address /45-23 F/f1/e 11 Zip 'q' 2 ('� City sPX qG, State /�� Phone( ��) ��� -(73-613 �� �� 8 VENT: Fan(s): EvapCooler(s): Hood(s): Duct(s)1: CD Miscellaneous: 2 Q. ° 10 APPLIANCE: Dryer(s): I 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. ft.): 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: I 100,001+ BTU: 18 TYPE FUEL SOURCE: Electric 0 ; Gas X; Oil 0 ; Coal ❑ ; Wood 0 ; Solar 0 19 TYPE DISTRIBUTION: Forced Air X; 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 APPLICATION OWNER OR DATE