HomeMy WebLinkAbout1984, 11-09 Permit App: 00003350 Insert MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name a )Fir ) /� (M) Department Use Only
%r_�(� f _ Project No.
2 Project Address(Not Mailing Address) ,9 /�' / Space Zip
2/, / G1 2*z.= �r---" .,/ ( . ..1..19‘*,7 ..ri, '''1 __3//,6 . %r
3 City/Commur''y Stat - Subdivision/Plat Name
4 Assessor P.rcg.
No. 1 Lot Block
16 Contr r Firm N me 7- Street Address
17 Zip
;yiesi_ /% Stata. Phone
9 9.�a 7 — _,�- _ (:�.�5') //--4 -// /7
18 /Cc$erson License No. y- Phone if different than above
i
8 (wner/ gent(if different than#'above) Business Address
9 Zip City State Phone
( )
15 Describe Work: ••,--14--".d..- .0 _- 4 .e -n.-/ &57-0-----e---d -_
New Addition/Alteration 0 Replace/Repair 0
10 cant/Na�e StreetJAddressg ,
6- ,-.1(e --ter-- 6 -'s-:v.'eJ� -/-7:-, 7,--,,_-,-"--- ,7/ .7-7/.ice,.._,7e31_ , ..-../-,-40,---c 7�
11 Zip City 7,-,,
State Phone
( )
* *
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:
F
10 APPLIANCE: (Wood Stovelf1je,/'1
Dryer(s): Range(s): Gas Log(s): lid Fuel: Gas Water Heater(s):
1-: 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
Z
W -
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:
U-
O -
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a,
›-
I-
0 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:
m
2
D: 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
Z
18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; Oil 0 ; Coal 0 ; Wood Solar ❑
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 1; Heat Pump 0
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.
5
SIGNATURE OF / APPLICATION
OWNER OR -e -_-.,; eg- --fi DATE ///94/