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1985, 08-05 Permit App: 00006696 Heater1- Z W 0- a 5 O W LL W > cc0 1•- O z W i 2 MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name (Last) (First) (M) ( 7 /'t -!,I /� li(i/; ��:i Department Use Only Protect No. C tP/max `i 2 Project Address (Not Mailing Address) . Space Zip 2). /pig -; j r ✓L -2c/ 3 City/ munity State % Subdivision/Plat Name 4 Assesi r Parcel No. b5 4 0(-O4 6 LotBlock 16 Contractor Firm Name ��/ JY y- ��f/Y:.�"'�,[.G� �'I /// 7't-f� Street Address y / 6!. �Ud es, /t -LG -l -C-4 17 Zip 9f,a.� City ,� / State 7v2. Phone % ,/ ( ) 3a J? 3/0c 18 ContactntPerson ,/ L/ GE.f c ! l-0--(---412-CX.: V License No. /,4='9 T I-/ - / o d' L/\/ Phone If different than above 8 Owner/Agent (if different than 41 above) Business Address 9 Zip City State Phone 15 Describe Work. New 0 Addltion/Alteration 0 Replace/Repair 0 10 Applicant Name Street Address 11 Zip • City State - Phone 8 VENT: Fan(s)' Evap Cooler(s) Hood(sp Duct(s) 1. /'7Y/,SO Miscellaneous: 10 APPLIANCE' Dryer(s): 1 Range sp 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: (eo6 13 REFRIG SYSTEM BTU: 1-100M: ,2 100-500M' 500-1000M: 14 1000-1750M: Other. Pressure Vessel (cu. t.): 15 COMPRESSOR/ HP. Less than 3: 13.15: 15-30: 30-50' 50+: 16 GAS PIPING SYSTEM: Number of outlets: C. 0 0 17 HEATING SYSTEM: 1-100,000 BTU: O of 4,3 0 S A/ 100,001 + BTU: 18 TYPE FUEL SOURCE. Electric 0 , Gas 0 ; 011 0 ; Coal 0 , Wood 0 ; Safer 0 19 TYPE DISTRIBUTION: ,Forced Alr 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 17 OWNER OR / APPLICATION DATE �S