Loading...
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.{ ^��`� ••,"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