1984, 10-01 Permit App: 00002644 Heat ExchangerMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name cipasp^ 'rst) (M)
Department Use Only
y
..---�t--Ir--�Cc._LA
Project No.
2 Project Address (Not Mailing Add s) a Space Zip
3 City/Community
State �-
�V L-
Subdivision/Plat Name
4 Assessor Parcel No
Lot
Block
16Contractor Firm Name
vti `_ , A V. -,r1 a
Str Zpddress
17
17 Zip C
I City
State
Phone
18 Contact Person
License No.
%>--I I E
W -T .i,Ls AS
-
Phone if different than above
8 Owner< \ nt (Itrddterent than ^above
Al --`-1‘54--0-0-v tom.{
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••,"us
Addr
toy' ss . T] �1yl
9 Zip
7 P J -a Jt
City
-,,.t,_
State
C.Ju
Phone V
,
15 Describe Work:
New / ` ® Addition/Alteration
0
Replace/Repair 0
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
Evap Cooler(s):
Hood(s):
Duct(s)1: K
Mlsceitaneous• @CFr, el,\�- 1"�' 6v,./..
10 10 APPLIANCE:
Dryer(s): 1
Range s):
Gas Log(s):
Wood Stove/
Sol Id Fuel:
Gas Water Heater (s)•
11 UNITHEATER(S)' Wall Mount: V N
Floor: V N
Suspended. Y N
12 AIR HANDLING: 10,500 CFM or less:
Moe than 10,000 CFM•
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M•
Other:
Pressure Vessel (cu. 1.)•
15 COMPRESSOR/ HP: Lam than 3:
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 0 ; 011 0 ; Coal ❑ ; Wood 0 ; Solar 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.
do -o
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
tsC DATE