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1985, 02-21 Permit App: 00004283 Mechanical Fixtures* H z W i a_ 5 0 W LL 0 a 1- z Q W to i z MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Nam / (Last) �(First) (M) 9 'li^i� I.AA AA.cx- Department Use Only Project No. 2 Project Address (Not Mailing Address) Space Zip S, 311/0 Mil 1.-/S a 3 City/Community State Subdivision/Plat Name 4 Assessor Parcel No. Lowes_ BlockI/2 S3 16 Contractor Firm Name SYv)/l/1f /J-egi,.MS Street Address r_ /o.2 A/0RQ 17 Zip 9,,z6-? City Sp State WA- Phone ( ) 3..)$-VL/7/ 18 Contact Person 0a cense No. Ili-?S- Frn3 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 ❑ 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): Gas Log(s): Wood Stove/ Solid Fuel: Gas Water Heater(s): -46'G -A--i 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: Less than 3: 3-15: 15-30: 30-50: 50+: d 16 GAS PIPING SYSTEM: Number of outlets: d _ a °�� 17 HEATING SYSTEM: 1-100,000 BTU: *T G '„51°- .)1000 100,001 + BTU: 18 TYPE FUEL SOURCE: Electric ❑ ; Gas ill ; Oil 0 ; Coal 0 ; Wood 0 ; Solar 0 19 TYPE DISTRIBUTION: Forced Air 4 ; 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 APPLICATION OWNER OR DATE a "4.21– S-S—