1985, 07-30 Permit App: 00006827 Heat Pump 5 r
- - - i MECHANICAL PERMIT APPLICATION WORKSHEET /&CIO
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name .2^ (Las qc2F m)c) \ (M) Department Use Only
�C�!/,(JJ/,�fi'c�7, '�[f// �.. Project No.
2 Project Address(Not Mailing Addr ) Space Zip
Ai //a2 O d&,122 /f 'fP7d‘
3 City/ unity State Subdivision/Plat Name
.5PComm , ,d /)�
OPP 08EP1/N TE ie
4 Assessor Parcel No. Lot I Block
175 i /30-7 , 1 -VT f &82--7
16 Contractor Firm Name Ste t Address
17 ZIp9•=2/'? City id � State �� Phone) ,c3 �7�L �
18 Contact Person S License No. ' Phone if different than above �~
041 I . .�1 R 6'► ,()d 'Cv/StA/ dfii 2.
8 Owner/Ac nt(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): EvapCooler(s): Hood(s): Duct(s)1: Miscellaneous:
10 APPLIANCE: Wood Stove/
Dryer(s): I Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
I--
11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
W
2
a 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
0
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
LL
0
} 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
I-
0 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 550+:
Z
Q
W 16 GAS PIPING SYSTEM:Number of outlets:
00
2
Z 17 HEATING SYSTEM:1-100,000 BTU: i
/ t4 _/2/g/iQ 100,001+BTU:
18 TYPE FUEL SOURCE: Electric 0 ; [ Gas 0 ; L Oil 0 ; Coal ❑ ; Wood 0 ; Solar ❑
19 TYPE DISTRIBUTION: Forced AIr ❑ ; 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 /-4, �� 7/34/?3---