1986, 12-02 Permit App: 00014416 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name
(Last)
'ST,e7
2 Project Address (Not Mailing Address)
(First)
v�T
Space
/j/- Yea a —/P �G,2� s S A:212
(M)
Department Use Only
Project No.
Zip
3 City/ mmunity
/°k4 N -
State
/��
4 Assessor Parcel No. Lot
16 Co ractor Firm Name j`
,11e414 C
C2.51
Block
Subdivision/Plat Name
2E -- Ela
& o ACS
17 Zip
'; L/�
18 Contact Person
City State
Street Address
Phone
./e C <Cc . %
8 Owner/Agent (If different than #1 above)
License No.
MUE140004
Phone if different than above
usiness Address
9 Zip
City
State
Phone
15 Describe Work:
New ❑
Addition /Alteration. 0
Replace/Repair 0---
10 Applicant Name
Street Address
11 Zip
8 VENT: Fan(s):
City State Phone
(
Evap Cooler(s):
Hood(s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
Range s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s): `
Z 11 UNIT HEATER(S): Wall Mount:
W
Floor:
Suspended:
a_ 12 AIR HANDLING: 10,000 CFM or less:
5
Q
W 13 REFRIG SYSTEM BTU: 1-100M:
LL
0
More than 10,000 CFM.:
100-500M:
500-1000M
W 14 1000-1750M:
a
r.
O 15 COMPRESSOR/HP: Less than 3:
W 18 GAS PIPING SYSTEM: Number of outlets: t "
03
Other: -
Pressure Vessel (cu. ft.):
15:
15-30:._.,
30-50:
i
Z 17 HEATING SYSTEM: 1-100,000 BTU:
Ci)
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric 0
as ❑ , . 011 ❑ ; Coa 'd ; Wood ❑ ;
Solar
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 abovei ormation'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. L; .•
SIGNATURE OF "' '� APPLICATION
OWNER OR DATE