1984, 06-28 Permit App: 00000944 Mechanical Fixtures*
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1
Owner's Name (Last
�—
(First) (M)
>� 1 -Project
Department Use Only
No.
2
Project Address (Not Mailing Address)
Space Zip
3 City/Community State Subdivision/ Plat Name
4 Assessor Parcel No �C L Lot Block
J
16
Contractor Firm Name
Street Address
17
Zip E.,t1yNORA
State
Phone
18 Contact Person icense No.
€xk
Phone if different than above
8
Owner/Agent (if different than #1 above)
Business Address
9
Zip
City
State
Phone
15
Describe Work:
T New
Addition/Alteration ❑ Replace/Repair ❑
10
Applicant Name
L
Street Address
11
Zip
City
State
Phone
8
VENT: Fan (s):
Evap Cooler(s):
Hood (s):
Duct (s) 1:O/ Z 1.
Miscellaneous:
10
APPLIANCE:
Dryer(s):
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
1000-175OM:
Other:
Pressure Vessel (cu. ft.):
15
COMPRESSOR/HP: Less than 3:
3-15:
15-30:
30-50:
T-50,:
16
GAS PIPING SYSTEM: Number of outlets:
17
HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18
TYPE FUEL SOURCE: Electric' ; Gas ❑ Oil ❑ Coal ❑ Wood ❑ Solar ❑
19
TYPE DISTRIBUTION: Forced Air
Radiant ❑ 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 iocal laws regulating construction or the performance of
construction.
SIGNATURE OF APPLICATION
OWNER OR z, DATE