1985, 05-07 Permit App: 00005517 Mechanical Fixtures*
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MECHANICAL PERMIT APPLICATION WORKSHEET
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PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND -6
1 Owner's Name (Last) (First) (M)
FI Ey/LI L.44111.1
Department Use Only
Project No.
2 Project Address (Not�i ing_Address) Space Zip
5 Z- (. e4eG.-r1-0.
3 City/Community
5 Po V-A& E
State
. AS a.
Subdivision/Plat Name
4 Assessor Parcel No.� 4/P5�
Lot
1 Block
55/
�
16 Contractor Firm Name
Tit, unl:l.ed µma-n*5
Street Address
A! f 3 rg rn4Pte.
17 Zip
gg2o1
City
5PolcAr.IL
State
k1445/4
Phone
( ) 32(.—Shoo
18 Contact Person
j2.0 n..)
License No.
TR.I UUKKT 157 co
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business Address
g Zip
City
State
Phone
( )
15 Describe Work:
New ❑ Addition/Alteration ❑ Replace/Repair ❑
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): t
Gas Log (s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s); 10,6 AL.
11 UNIT HEATER(S): Wall Mount: Y N
Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or leas:
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: Z
17 HEATING SYSTEM: 1-100,000 BTU: f oo i o e o
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas 121 ; 00 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air Fir ; Radiant 0 ; Heat Pump
1* limber 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
OWNER OR .1"22AAAL-
APPLICATION
DATE 5-?-8�