1986, 04-29 Permit App: 00010897 Mechanical Fixtures y K -
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last)/--(1).,_ (First) t (M) Department Use Only
_e'AN4:'t ` Project No. ffiFir-
2 Project Address(Not Mailing Address) Space Zip
3 City/Comr pity State Subdivision/Plat Name
4 Assessor Par el No. Lot 1 Block
16 Contractor Firm Name Streott,Address
C=31"—Q-
Q {} / 2 /,f/ 4---4-,—1
17 ZipCity State Phone f --i
18 Contact Person License No. Phone if different than above
8 Owner/Age (if different than 81 above). Business Address
r
• a L-4-__tN.� � �1,-_-4-A ` I // r)—/ ( . —c- ,
g Zip / �/ City State Phone
/y 1.Y �C_ i„..)__e)---t2----r—ti`,11—- 1.-. tic)---. ( ) ,d !t /� f15 Describe Work: ([
New Addition/Alteration 0 Replace/Repair 0
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): I Range(s): • Gas Log(s): Solid Fuel: Gas Water Heater(s): `., 1
1- 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
W
a12 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
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a
>-
O 15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 30-50: 50+:
Z , I i
Q
W 16 GAS PIPING SYSTEM:Number of outlets: 1
co
Z 17 HEATING SYSTEM:1-100,000 BTU: ( (��7 100,001+BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas C OII 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forcod Air X; Radiant 0 ; Heat Pump
3�
1* Number of separate zones for any heating, A/C or air handling system. 5;'-'
,
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.
ALDENDORF rURNACE
SIGNATURE OFA DIVISIONre, 4f I-di`rg d , Tli$d ,IVY
APPLICATION
OWNER OR y‘•-•
tp•, :!tft,A DATE `7 -e`'-,F .
JRA
NE,_. NE, ', A 99206