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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 /