1985, 07-10 Permit App: 00006422 Air Handler•
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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1 Owner's Name Last) A ,(First) _ (M)
tvA �i ,ui k,-
Department Use Only
Project No.
f
2 Project Address (Not Mallin, Address) Space Zip
(11..r- :/` 4–. VP E----
3 City/Community
Sil ermoi-10��
State
a)A
Subd' cion/Plat Name
UFPoe-'un,r ry
4 Assessor Parcel No.
/65`ill— 050
Lot
I Block
15 3
!
'/7/'em,
16 Contractor Firm Name
Nio�o , A>412,06°°( -4,W &t�
`to,c,/e
Street Address
. i e./ --127-
17 Zip
City ^ fi/f/A `4
(1C
State
Phone
7) C 7,—
7
18 Con Per •
License No.
Phone if different than above
8 Owner/Agent (if differ :,% than #1 above)
Business
Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New /– Addition/Alteration
❑
Replace/Repair ❑
10 Applicant Name
/i4'`Iifc A– 27
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
Evap Cooler(s):
Hood(s):
Duct(s) 1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
1 Range(s):
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(S): Wall Mount: Y N
Floor: Y N
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. t.):
15 COMPRESSOR/ HP: Less than 3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas 0 ; 011 0 ; Coal 0 ; Wood 0 ; Solar 0
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
OWNER OR
APPLICATION
CV • # / � DATE 7l 0g�%
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