1984, 10-05 Permit App: 00002772 InsertMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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.
SIGNATURE O
O
OWNER OR' � . �'```� '� DATE
APPLICATION
(Fir ) (M)
Department Use Only
1 Owner's Name (Last) •
A / �/
Project No.
2 Project 'ect Addr s (Not Mailing r Space Zip
/1,--- zey 6
3 Cit! mmunity
State
vi�sionlPlatN'�ame / /e'rr,lic° fe s 7tr Dis / PTA
4 Assessor Parcel No.
el 55 / - d'zp
Lot
Block
• 2772
Name -
Street Address
16 "Go ractor Firm
A - �rf.--• _Lef-4-----r ei-Oye—.--,..1-7
_71
���/_.. -- - .4 -4 -4 -e --/-e-14. ,,
17 Zip
City
Sta_
Phone
18 Con•erson
Y.
License No.
.
!,
Phone if different than above
8 owner/A.:nt (if different than k1 , •.ve)
��
Business
Address
9 Zip
City
State
Phone
(
15 Describe Work: /
New ® Addition/Alteration ._
ReplacelRepair L1
Street
Address
a -rt - u --
10 �pp)ic.nt Name ,r, ------,
/pe-4-� -Y. � - ,t L
11 Zip �
////
City //
State
Phone
8 VENT: Fan(s):
Evap Cooler(s):
Hood s):
Duct(s) 1:
Miscellaneous: --� } -'
'
10 APPLIANCE:
f
Wood Stove i -
/ .C- .0 - �- !moi.. C>'Y'- --A
Dryer(s):
Range s):
Gas Log(s):
Solid Fuel:
Gas ater Heater(s):
-11 UNIT HEATER(S): Wall Mount: Y N
1
I Floor: Y N
l
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or less:
More than 10,000 CFM:
i
J 13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
J 14 1000-1750M:
Other:
Pressure Vessel (cu. t.):
) 15 COMPRESSOR/ HP: Less than 3:
3-15:
15-30:
30-50:
50+ :
L
LI 16 GAS PIPING SYSTEM: Number of outlets:
0
3 17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric E ; Gas C/ ; Oil 0 ; Coal 0 ; Wood �" Solar F.
19 TYPE DISTRIBUTION: Forced Air 71 ; Radiant (X; Heat PumpL]
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.
SIGNATURE O
O
OWNER OR' � . �'```� '� DATE
APPLICATION