1985, 05-30 Permit App: 00005825 Heating System*
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last)
( Fir (M)
Department Use ly
[ t0`.`Xow1
►
1 IO.Y'�.l 1
Project No. a�
`'
2 Project Address (Not Mailing Address) ,s— `
3 1 S C'S Le
Space Zip
C.'T
3 City/Community
State
A `
Subdivision/Plat Name 1_
4 Assessor Parcel No. iii
Lo
Block
16 Contractor Firm Name /—t Nc� "� \A •Q• 1H
Str ddre\ O ` 37 �v
17 Zip 9 a o3
CI �O 1�ON�.
Stat
k -0C --...s
Phone
3 ' 1-1-5c13
18 Contact Person
110 Gt4 -
License No.
GloA; •. c. . Cr,
Phone if different than above
o.
8 Owner/Agent (if different than 61 a• • e)
Business Address
g Zip
City
State
Phone
( )
15 Describe Work:
New ❑ Addition/Alteration ❑ 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:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I Range s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNITHEATER(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. 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: j.% 00 t3
!!
100,001+ BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant K1 ; 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 cance provisions of any state of local laws regulating c�tion or the performance of
construction. `� _ WO -AL. 1
SIGNATURE
OWNER OR
APPLICATION ✓ i
DATE