1984, 10-10 Permit App: 00002927 Heat Pumpt
1-
z
w
0
5
w
LL
0
w
a
>1—
cc0
z
w
z
MECHANICAL PERMIT APPL1PATION WORKSHEET
/
PLEASEPRINT,AND CQMP_LETEONLY THQSEPARTS Q ZHE FORM Y_QU UNDERSTAND_
1 Owner's Name /1 (Last) t (First) (KA/VC?.
n CC 4//q,v f 1 I ftittI S 1 M�
1 Department Use Only
Project No.
.,�
2 Project Address (Not Mailing Address) Space le -i, Zip
E 7315 ill ARAE. .+4.0.
3 City/Community
$Po )c.Aae
State
w As u,
Subdivisipqlat Na a j �
( ire h�.�frc/ /Aft /Y (ICI
4 Assessor Parcel No.
/25-3/ — .1oo�.,
Lot
I{
I Block
2Q 27
16 Contractor Firm Name
K Tu
Street Address
/3.V nl •¢5N
17 Zip
992ot
City
5PoKArve
State
w4.54.
Phone
( ) 3 ? c - 56 co
18 Contact Person
0/j
.r
License No.
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New ❑ 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
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. ft.):
15 COMPRESSOR/HP: Lessthan3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU: q - Pup' p (A -a0 on))
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric IC ; Gas 0 ; 011 0 ; Coa 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat Pump rL7 '
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.
SIGNATUREy�
OWNER ORF----9 -� i!// o R.R/5
APPLICATION
DATE /o — 10