1985, 07-12 Permit App: 00006367 Water Heater*
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MECHANICAL PERMIT APPLICATION WORKSHEET ear
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
``i 1 1
� � 1 ` `Q .'ed � \�� � ®Ya�..J1
Department Use Only
Y
Project No.
2 Project Address (Not Mailing Address) Space Zip
E. IA': -)1g‘ G,..ti.cve.
3 City/Community
State
c
Subdivision/Plat Name
t11'% C2csr 4c !sr
4 Assessor P rcel No.
215 VI!2-142-4
LotBlock
8
2
6-' i
16 Contractor Firm Name
C-7 4 �-•rc kA. e ra .,, N.
Street Address _
t o a - 37 ivk.
17 ZipCA YAQ�
Cit0 c
State`'
Phone H g a --
18 Contact Person
IIIII. tin
License No.
► t..
c., 4 . C.C„
Phone If different than above
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8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New 0 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:
Miscellaneous:
10 APPLIANCE:
Dryer(s): I
Range s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(S): Wall Mount: Y N
Floo
: 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: Less than 3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU: .......**-.I 946.,..e. 1.0‘,. "Iv
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas j1---- Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 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
OWNER OR
APPLICATIO
DATE 7 g`