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1984, 10-23 Permit App: 00003094 Water HeaterF Z w 2 0 5 0 w IL O w a 0 0 Z cc w m 2 Z MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name (L t)(//Fi'r's) / . - (M) 74,3 Yi1-4,.-1v Department Use Onty p, Project No. 2 Project Address (Not Mailing Address) Space Zip E: i /r -O3 6-4.e-- g yzoG- 3 City/Community State Subdivisl�at Name C'� �7 4 Assessor Parcel No. •2.-S544 -071'1 Lo lei Block .7 u 16 Contractor Firm Name ,..-....7e, dA q - Kii-J— -.4`7" Street Address - c. 4 . a 76.7 17 Zip 4'lzzo City dGatca. State '0 Phone ��4 ...(. ) 39.1/70 t' Phone if different than above 18 Contact Person 4 i.52/zL.861-0V - License No. 3.12 -CL - - 72A) T 8 Owner/Agent (If different than 01 above) Business Address 9 Zip City State Phone ( ) 15 Describe Work: New 0 Addition/Alteration 0 Replace/Repair 0 10 Applicant Name Fd'i�1-d--�� Street Address a ' //?o3 t�a� 11 Zip 1' 976'6 CityState �./b/Cit.fv _ ) /e /1k, Phone ( ) :7 - 7c.7 8 VENT: Fan(s)' Evap Cooler(s): Hood(s)' Duct(s) 1. Miscellaneous: 10 APPLIANCE' Dryer(s). Range s): Gas Log (s): Wood Wood Stove/ Fuel. .. Gas Water Heater(s): /G , ) -Y -1 C 11 UNIT HEATER(S)' Wall Mount' Y N I Floor Y N Suspended' Y N 12 AIR HANDLING' 10,000 CFM or less' More than 10,000 CFM: 13 REFRIG SYSTEM BTU: 1-103M: 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 PIPINGSYSTEM' Number of outlets' 17 HEATING SYSTEM: 1-100,000 BTU' 100,001 + BTU: 18 TYPE FUEL SOURCE: Electric 0 , Gas '0 ; Oil 0 , Coal 0 ; Wood 0 ; Solar Eln 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 OF // /J /� J /, OWNER OR `� ( LLL�.(' /L/rl�ce— APPLICATION /�J//�/Dr DATE D