1984, 11-12 Permit App: 00003375 Mechanical Fixtures MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
•
1 Owner's Name (Last) 1First) (M) Department Use Only
a �t p .�/ ��s Project No.
2 Projectn,,/,? c,,
Addressd (Not Mailing Address) `(d JFK Space Zip
./ f f,/,-rte+f,- `1/..� ((/1I P,?-�i1s- / l \.rJ•-s\-�'�.-".-- Cr p ?C:
3 City/Community State Subdivision/Plat Name
4 Assessorparcel No. Lot Block
3375
16 Coonntractpr Firm Name Stet Address ...,�
17 Zip City State Phone
18 Contact Person License No. Phone if different than above
8 Owner/Ag (if different than#1 above) /. i�
ent Business Addressz---)/ 7 77
�(----k-----) ---51-
(-- - :-.-0,_1' — J
` / /2' r.: --.-J.-- 5, /CC--C)
9 Zip 1 City State Phone h t f�i
., cfr-C, `t; ,SV -a'--Lh•.'V_ (1,_ _J l� ( )
15 Describe Work:
New,.3\ Addition/Alteration ❑ Replace/Repair ❑
10 Applicant Name Street Address
(1--61/4),-__4_/. 0,_ 7"
11 Zip City State Phone
( )
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: C;is
Miscellaneous:
i 1
10 APPLIANCE: Wood Stove/
Dryer(s): 1 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
2
sL 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
o
W 13 REFRIG SYSTEM BTU: 1-1001vt:� 100-500M: 500-1000M:
o /
a14 1000-1750M: Other: Pressure Vessel(cu.ft.):
›-
I-
0 F--
0 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 X Gas ❑ ; Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar D
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; Heat Port)�
1* Number of separate zones for any heating, A/C or air handling system. T:34 `t_
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 a 1 J APPLICATION •
OWNER OR _CV-d..,�ct4,�- ' - - DATE //-O0) --i