1985, 01-07 Permit App: 00003860 Furancew
1—
Z
w
a
5
0
w
LL
0
w
a
>-
1-
Z
cC
w
m
Z
-/7020
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M) Department Use Only
GO ,Q k_ l.S 3', w1 Project No.
2 Project Address (Not Mailing Address) Space Zip
3 (o a S 3 . to 2,0TA
3 City/Commun/iitty
State
Subdivision/Plat Name
4 Assessor Parcel No.
Lot
1 Block
38 66
16 Contractor Firm Name
Swliri-►
Street Address
E_ /O NoRA
17 Zip
89020 $.
City
5730/64,.,,e
State
wA-SP
Phone
( ) 3) k- y(/3/
Phone if different than above
18 Contact Person
/a>
License No.
aia5---EA)
a
8 Owner/Agent (if different than 41 above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New `it Addition/Alteration
0 Replace/Repair 0
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
Evap Cooler(s):
Hood a):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I Range(ar:
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: 130-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric K ; Gas 0 ; Oil 0 ; Coal ❑ ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air IX; Radiant 0 ; Heat Pump El
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 &,_a ✓�� APPLICATION.�_t5OWNER OR DATE )`