1985, 01-11 Permit App: 00003908 Water HeaterH-
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
J
1 Owner's Name h\,), �1 #JLast) J/) (First) a (M)
Department Use Only
b^—�,—Q.-L--L ` ^.� /1 �I l/
Project No
2 Project Address (Not Mailing Address) Space Zip
j Gy 1 /
3 Cif/GommunhI
�"f vo22.t--I4..f.-
State
610 A
Subtly
Subtli a:on/Plat
-J7/,1or%cnvi-/y
Name
fir of B 2Q7
4 Ass or Parcel No
085�fIf — r/5
Lot
Block 'I
16 Contractor Firm Nam9,, C.
Street Address
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17 Zip I
1—.(9
City t
r
State
Phone
Phone if different than above
qee
18 Cont�ct Person
i�ti4A.b. C -.2c.«%
,
License No.
ninOnti HE
-)SNS
8 Owner/Agent (If difterent than #1 above)
Business Address
g Zip
City
State
Phone
( )
15 Describe Work.
New ❑ AdditionlAlteratlon
❑ Replace/Repair
10 Applicant Name
Street Adpress /, fm a
11 Zip 1l,,
(� l/ I J �Ji
City,—
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/
a./
State%
'✓ \� /{
Phone J 1 -'I f,� Y r /
( ) F rte. /Ci 'l/ _,-
8 VENT' Fan(s):
Evap Coolers)
• ood s)
Duct(s) 1:
Miscellaneous.
1
10 APPLIANCE:
Dryer(s).
Range s):
Gas Log(s):
Wood Sto el
Sol Id Fuel:
v oft Q. r9t) �1 d,#11,._/,1. -L
Gas Water Heater(s): .. +/ — j
11 UNIT HEATER(Sp Wall Mount: Y N
Floor. Y N
Ll
Suspended Y N y I% // �'P �"�
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:
50a:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001+ BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas M,Ci Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat Pump 0
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 '
DATE