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1984, 09-18 Permit App: 00002346 Woodstove* H z w i a 5 0 w LL O > w 0 1- 0 Z cc w m i z MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name (Last) (First) (M) G i EENI w d 0 0 P* C Department Use Only 2,3 Project No. 2 Project Address (Not Mailing Address) Space Zip L.. AST '1 k a I rn A R I .-1---t 1,1- 'kV E 3 City/Community1 State Sf6k�� (nric.L wo0j (V4 Su Ision/Plat Nam?....., / �// ie6 K.--(.1Sid Witt lfmfe// 4 Assessor Parcel No. 61542- // /6 Lot Block 16 Contractor Firm Name Street Address 17 Zip City State Phone ( ) 18 Contact Person License No. Phone if different than above 8 Owner/Agent (if different than 41 above) Business Address 9 Zip City State Phone ( ) 15 Describe Work: New ie..-- Addition/Alteration ❑ Replace/Repair ❑ 10 Applicant Name Street Address 11 Zip City State Phone ( ) 8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duet(s)1: Miscellaneous: 10 APPLIANCE: Dryer(s): 1 Range s): Gas Log(s): Wood Stove/ Solid Fuel: E 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. t.): 15 COMPRESSOR/ HP: Less than 3: 3-15: 15-30: 30-50: 50+: 16 GAS PIPING SYSTEM: Number of outlets: 17 HEATING SYSTEM: 1-100,000 BTU: 100,001 + BTU: 18 TYPE FUEL SOURCE: Electric ❑ ; Gas 0 ; Oil 0 ; Coal 0 ; Wood Solar 0 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 OWNER 0 &ve APPLICATION 9r/j� DATE