1985, 08-09 Permit App: 00006945 AC, Damper ,� -
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name 1 I (Last) f ;4#st) (M) Department Use On , `
el...teU. ., vtit',,�1 Project No. �,q('/
2 Project Address(Not Mailing Address) / Space 1 i)
3 City/emmunity ,1 State Subdivision/Plat Name
"J A-- Vt.l Li—C(Z»51 PA 2%C., 1sT 4 ori
4 Assess r arcel No. LotBlock
)-C,LI/' r' -;ifs t.0 1 Z lc'bx ( 3d S
16 ntractor Firm N Street Address j ( 1 // r ,
A
4L& t4144 /r�L7/ 0 ,.. �'�°clL �17 Zip i Stat Phone
18 Conta,,Persgn j., License No. Phone if different than above
t!:/1 ,:fit. 9 %0 fFfill Q 44 -} E - /13 P/ I
8 Owner/Agent(i different than#1 above) Business Address
9 Zip City State Phone
( )
15 Describe Work: jt O C1-4-1(
el& & c() R T 14 A c 'I_ �v_e_ ,
New ❑ • Addition/Alteration `A. Replace/Repair ❑ cqz! %A
10 Applicant Name Street Address
11 Zip City State Phone
1 )
* *
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: 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
a12 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:
Li_
O
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
a
I-
O 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
Z
Q
W 16 GAS PIPING SYSTEM:Number of outlets:
c0
2
J 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
Z
18 TYPE FUEL SOURCE: Electric ❑ ; Gas X; Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
19 TYPE DISTRIBUTION: Forced Airdiant ❑ ; Heat Pump
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 OF ir, APPLICATION // _
OWNER OR _� � ���' DATE `7 /