1987, 11-02 Permit App: 87003786 Mechanical Fixtures D
MECHANICAL PERMIT APPLICATION WORKSHEET `
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND /1-C)
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l(WC) 4S
1 Owner's Name (Last) Al (First) (M) Department Use Only ��
.L D /..L77},Q,C ,., , Project No.
2 Project Address(Not Mailing Address) Space Zip
. /00/6— C.))/f/N6)fi '4,v
3 City/Community State Subdi n/Plat Name
,-- 0/‹.AN e- LAR CK 5
4 Assessor Parcel No. Lot Block
064-011!1 rc - 1
16 C9ptractor Firm Name Street dress �.
17 ZipCity State Phone
18 Contact Person / License No. Phone If different than above
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8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone •
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( )
15 Describe Work:
New ❑ Addition/Alteration 0 Replace/Repair 0
10 Applicant Name Street Address
11 Zip City State Phone
( )
* .... 1 r
j 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): (i) "SI. �
Z 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N •
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2
a. 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
O 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
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0
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a.>-
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HI Z 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
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W 16 GAS PIPING SYSTEM:Number of outlets:
m
D 17 HEATING SYSTEM:1-100,000 BTU: 0\ /,9 Da- 100,001+ BTU:
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18 TYPE FUEL SOURCE: Electric 0 ; Gas (; Oil 0 ; Coal 0 ; Wood ❑ ; Solar 0
! 19 TYPE DISTRIBUTION: Forced Air 0 ; 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.
1SIGNATURE OF 'art +d Ki" "° '".0E' 1.4E "itat.INC APPLICATION
OWNER OR y�gay A4 :NE. .DATE ///��57
✓jll`il�r VIA 99 /
918-8252