1984, 08-06 Permit App: 00001797 Water Heaterw
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Lastt . (First) (M) 1 Department Use Only 7yq
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yi /,rcto yam, t Project No. s
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2 Project Address (Not Mailing Address) Space Zip��—r
303 s �� flz
6-3
City/Community
State
Subdiv on/Plat Name
ttSe
4 Assessor Parcel No.
3512— /2/6
Lot I
/ 0
Block
3
I
16 Contractor Firm Name
I St7 Address 3 77
17 Zip
274/
City
3f2oice%"
State 1
x JPe
Phone
( 604) (I-176
18 Contactson
A
License No.
iia'—
ice— J/
T
Phone If different than above
8 Owner/Agent (If d fferent than 01 above)
Business
Address
g Zip
City
State
Phone
( )
15 Describe Work:
New ❑ Addition/Alteration
❑
Replace/Repair Ile
10 Applicant Name
,-;e•ir k
Street
Address
z1�s.6,
11 Zip 99zd�
CIty 6�O E
State
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Phone( ) 907,54 6 '/6,
8 VENT: Fan(s):
Evap Cooler(s):
Hood s):
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:
-Dryer(s):
Waal Stove/ _ _ _— _.___"_---
Gas Water Heater(s): on<
Solid Fuel:
Ranges):
Gas Log(s):
11 UNITHEATER(S): WallMount: Y N
Floor. 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:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas -le< 011 ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
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 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 Si/ 40 `4
1