1985, 01-16 Permit App: 00003961 Mechanical Fixtures*
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
32 41--o o3
1 Owner' gNa l f 0 (Last) � (First) le D (M)
Ij//���1 "Ir
Department Use Only
Protect No. l/P_
2 Project Address (Not Mailing Add i � �� � f � � Space Zip
3 City/CQ_mmunity
C• 0KArt1 CT..
State
We
Subdivision/Plat Name
4 Ass r Parcel No.
2544—
o 01
Lot
4
Block
16 Contr for Firm N m
Street Address
17 Zip
6,D
t �
®/t lam'
Stye' f
7¢
Phone
( ) '— 0 0
18 Con Pe
License No.
Phone If different than above
8 Owner/Agent (if different than M1 above)
Business Address
9 Zip
City
State i Phone
( )
15 Describe Work:-.' l ✓d2A-4
�n New l, f{ -i Addition/Alteration Replace/R ❑ 1/
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
Evap Cooler(s):
Hood(8):
Duct(s) 1:
Mi "i" `, '4,-,y
-C-4,4 -2---/...- r.,
� 1
L
10 APPLIANCE:
Dryer(s):
I Range s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(S): Wali Mount: Y N
Floor: Y N I
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 1000-1750M:
Other:
Pressure Vessel (cu. ft.):
15 COMPRESSOR/HP: Lessthan3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Numbero€outlets:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas 011 0 ; Coa 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air Radiant ❑ ; Heat Pump ID
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 ei
APPLICATION /
- j
DATE