1984, 10-02 Permit App: 00002699 Heat Pumps ,
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
UQA tri/..11 f j-10‘. N Protect No.
2 ProjectAddress(Not Mailing Auer ret 5 Space Zip
/ / id-G oG—,rc _ YYY C)/."--time Ci t,A. k. 99.i_<, c
3 City/Community State Subdivision/Plat Name
n c?--.. o
4 Assessor rcel No. Lot 1 Block
. 4)9. .
16 Contractor Firm Name Strut Address
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17 Zip -2
City / State 6 Phone
yc(4 I(-0,0- ati ----1—x-Q,4-4,c,L Lt. ( ) foi-r 1' Sj.
18 Contact Person License No. Phone if different than above
' ,4--)- — 2-- fl-F-446
8 Owner/ t(if different than#1 above) Busi Address
' k - �.�r-•- 7/J / I
9 Zip City State Phone
15 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): Ducts) : ) Miscellaneous:
10 APPLIANCE: Wood Stove/
Dryer(s): I 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
1
a 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
O5 It
W 13 REFRIG SYSTEM BTU: 1-100M:d-/1oe oi6((,U 100-500M: 500-1000M: /;
O
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
O 15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 130-50: 150+:
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W 18 GAS PIPING SYSTEM:Number of outlets:
m
2
D 17 HEATING SYSTEM:1-100,000 BTU: 100,001+BTU:
Z
18 TYPE FUEL SOURCE: Electric Gas 0 Oil 0 Coal 0 Wood 0 Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat Purrs
CN t
1* Number of separate zones for any heating, A/C or air handling system. 3j
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 OFAPPLICATION
OWNER OR ),4-__ t(1_ 1),, ,,i,.e.a DATE l'0 —,.1_---5'—