1985, 04-15 Permit App: 00005020 Water Heater, Piping •
Sr
MECHANICAL PERMIT APPLICATION WORKSHEET /65-66
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Air:-
1 Owner's Name „... (Last) (First) (M) Department Use Only
-. 0 S Project No.
2 Project Address(Not Mailing Addr`ess) Space Zip
3 City/Community State Subdi on/Plat Name
�n . ---14(a1 \ c L) (2s1LLe Acid
4 Assessor Parcel No. Lot Block
16 Contractor Firm Name _ ,Street Address s_
C":51iw!cl State kcN� ecoe.0....\ k E ‘C A3 - 37'1'11/4' \) i
17 Zip City Phone
9 61 &:)3. ._ \kl... 30 145 9
18 Contact Person License No. Phone if different than above
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
15 Describe Work:
New ❑ Addition/Alteration ❑ Replace/Repair ❑
10 Applicant Name Street Address
11 Zip City State . Phone
( )
* *
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
10 APPLIANCE: Wood Stove/ / j�j KO
Dryer(s): I Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s)” i ) *'
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:
t1
0
d14 1000-1750M: Other: Pressure Vessel(cu.ft.):
>-
I-
O 15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 30-50: 50+:
Z
Q
W 16 GAS PIPING SYSTEM:Number of outlets: 2-
032
Z 17 HEATING SYSTEM:1-100,000 BTU: 4,---- 100,001+ BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas I Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Air ❑ ; Radiant ❑ ; Heat Pump
1* Numb separate zones for any heating, A/C or air handlin system.
I certif at the a ole information as ubmitted byme is true and correct and further, ree that all 9
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 C\ APPLICATION .
OWNER OR -<____
•_ ,..n....L- L_' ��,ty ,J—Li<�tm DATE i /4
1.