1986, 07-17 Permit App: 00012205 Mechanical Fixtures , MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name 4(Last) Sry) (M) Department Use Only l
Project No. !:4-/
2 Project Adddr s(Not
SNoott Mailing Addre s n Space Zip
7/k /Ccr_... .. .0
3 City/Community State Subdivision/Plat Name
4 Assessor Parcel No. Lot I Block
16 Contractor Firm Name ' StrAddress
\---Q Cr y... C 'T- 0-lk_ii..__, CA -,d1/ N'-'4.- -...,-L
17 ZipCity State Phone
?d-� I I (-_1J-_, ( ) y0)---?-f LfL
18 Contact Person License No. Phone If different than above
8 Owner/Agent(if d' rent than#1 above), Busi Address
I0 ' /02 C,01--)-‘ Ak-4,--/"--)*-4---)
g Zip City State Phone
15 Describe Work: ��\ ///
New L� Addition/Alteration ❑ Replace/Repair 0
10 Applicant Name // Street Address
..4.--rt.� (� X76
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): c (�j
1- 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
Z
W
d12 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
O
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a
>I-
O 15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 30-50: 50+:
Z
Q
LL 16 GAS PIPING SYSTEM:Number of outlets: �J
( )
to �
2
D 17 HEATING SYSTEM:1-100,000 BTU: 100,001+BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Alr ; Radiant 0 ; Heat Pump
1* Number of separate zones for any heating, A/C or air handling system. 33 `�`
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.
ALL)r.‘1 ,:, , !-tk,4
SIGNATURE OFiS;CP) x APPLICATION
OWNER OR E .
. .T.,, . . y DATE %/2 -/
S NL, WA ./ 206
928-8252