1985, 06-19 Permit App: 00006071 Air Handler "C
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name ) / (Last _ - (First) (M) Department Use Only
( L7 / 1`. Project No. ;:
2 Proj@ct Address(Not Mailing ddress) i Space Zij
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3 City/Community ) State Subdivision/Plat Name
4 Assessor Parcel No; Lot Block
16 Contactor Firm Name Stmt Address _
Ne/i/?z' 1`/06' S�'- A,` (_,-/td 1 z'i`t/ ' (,;E., '.S% ..// 't' T
17 Zip City State Phone
18 Contact Person License No. Phone if different than above
0 A/;_�t1. :7•-.;?d XJ ? e.)/7A t 70/? 2--
-
8 Owner/Agent(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): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
10 APPLIANCE: Wood Stove/
Dryer(s): Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
Z 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
W
a12 AIR HANDLING: 10,000 CFM or less: X More than 10,000 CFM:
5
o
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
L.L.
0
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a
>-
I-
O 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
Z
Q
W 16 GAS PIPING SYSTEM:Number of outlets:
m
2
Z 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
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 i,' - �' APPLICATION / f
OWNER OR %. `,e -{C' f.- A,.1, ' G ( i DATE 6/1 G ?..5