1984, 09-07 Permit App: 00002295 Heat Exchanger•
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (M) Department Use Only 2 295
-3
4ast)(First)
./'') IT me Project No. 7
2 Project Address (Not Mailing Address) Space Zip
082. 1J 1lff.sSPr
3 City/Communit.WS
essCr
State
Subdivision/ Plat Name
4 As Parcel No.
Lot
Block
19—Contractor Firm Name// I %
jQSOW 4 i/ized fh?--7,iv 4-- /12/ C
Street Address
E . of 2 o Miss/ on)
17 Zip
gQ2v-
Ci
�CA-NL
St,ate l
(,04
Phone
( ) .53S-4333
18 Contact Person A
License No.
Phone if different than above
8 Owner/Agent (if different than 41 above)feg
L i= .02- Z
Business
Address
g 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 (8):
Hood(s):
Duct(s)1:41‘s--0
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I Range s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(S): Wali Mount: Y N
le
Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or less:' i 4Ai.-5L�
6FE
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:4'—;?4:)` Or5 11/1N)
/A)
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric X ; Gas 0 ; 011 0 ; Coal 0 ; Wood 0 ; 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 OF
OWNER OR
APPLICATION ck
DATE �ig4
•
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