1985, 08-01 Permit App: 00006977 AC MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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1 Owner's Name (Last) (First) (M) Department Use Only / 7 7
R
Roo-E-'es, i./.1-Re,6 D Project No. (+�
2 Project Address(Not Mailing Addres§) Space Zip
S. ''rl 4 ETA 99-2/L
3 City/Community State I Subdivision/Plat Name
$PDKANE ` ( 9- , I PlkitMPrIVyV -2 5 ( ,1
4 Assessor Parcel No. �,�j !� 2-50--'
� Lot Block
Z2 4 1 �. K7-__. l M!C(`(P
16 Contractor Firm Name _ Street Address
6N/YER f a R,v,4 e E 5/- Fte�'z Lire A/, /., hl4=LFiv/st
17 Zip City State' '/ Phone
��2D�- 5('6,1(74,,,v E (�/ (3-Lrr) 3.5-/ 7//
18 Contact Person License No. Phone if different than above
f-", 4.zip/ . 8.4,10YEcF37gwr
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
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15 Describe Work: 11 _ 0��ft14,�4; 6 S'/ .b/
,, j2,- Leit,g ew�i' "/y L�£ Addition/Alteration ❑ Replace/Repair ❑
10 Applicant Name v Street Address
11 Zip City State Phone
( )
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8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
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10 APPLIANCE: Wood Stove/
Dryer(s): Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
F- 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
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2
eL 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
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W 13 REFRIG SYSTEM BTU: 1-100M: T 100-500M: 500-1000M:
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W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
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O 15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 30-50: 50+:
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Cr 16 GAS PIPING SYSTEM:Number of outlets:
m
2
: 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
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18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; Heat Pump
1* Number of separate zones for any heating, A/C or air handling system. .. O, C1
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 %9 APPLICATION >T-
OWN
OWNER OR a.,1-,..e....- DATE _`