1985, 06-04 Permit App: 00005844 Range, Water Heater A - MECHANICAL PERMIT APPLICATION WORKSHEET
, PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) -- . c2.\: 1\1%
(First`) \_ (M) Department Use;Only-1 -
I Q Z``K'e. .a 1�YA\ I Project No.
2 Project Address(Not Mailing Address) ` Space Zip
1b
3 City/Community State V Subdivision/Plat Name
om
d� o \c) D01352 A vrc%
4 Assessor Parcela. Lot Block
11.64r-t - Ot:: 1
16 Contractor Firm Name Street Address
G •to ece%,c.'�. NkAP_ca t i..1 c E 10 3 - 3 7 t t" �0.e J
17 Zip C./ l AO 3 I .>�CitySt tae Phone
`15 a 3
18 Contact PersonsLicense No. \ ,w Phone if different than above
8 Owner/Agent(if different than#1 above) Business Address
g Zip City State Phone
( )
15 Describe Work:
New ❑ Addition/Alteration ❑ Replace/Repair ❑
10 Applicant Name I Street Address
11 Zip City State Phone
( )
* *
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
10 APPLIANCE: Wood Stove/ 6k
ic '+2,e45
Dryer(s): Range(s): I 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
2
a_ 12 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
d 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
>-
I-
0 15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 30-50: 50+:
Z
Q
CC
w /,..,
_16 GAS PIPING SYSTEM:Number of outlets: C7
W �[.i
m
Z 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU: f`
L, c C7 C.)
18 TYPE FUEL SOURCE: Electric E ; Gas ❑ ; Oil ❑ ; Coal ❑ ; Wood E ; 74 7�t a Ce,
f19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; Heat Pump❑ n "Z)
1* Number of separate zones for any heating, A/C or air handling system. \ _
TWA,io..1� o.% C-OOk1'Wq 1.4t_ - -iske gLe t qa s ./W(ZAN" h2 OhNe.�
I ertify that the abbk information as sdt mitted I3'y me is true arkd correct aAd 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 Z..41.t.x.x.ttiatti, APPLICATIOOWNER OR DATE 4o 'K-gg