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1984, 09-06 Permit App: 00002325 Mechanical Fixtures} MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND H z w 2 a_ 5 O w u - O w a >- t— z cc w co 3 Z r (F' st) (M) 1 Ownwneerr''��syyy�111am`elJ Department Use Only S-% �J /(L/a�tr �` (--C� -3 Project No. b. ._. C� /7 C_ 2 t Address (Not Mai lin dress) Space Zip n 3 City/Community Slate Subdivision/Plat Name 4 Assessor Parcel No. Lot Block 16 Co tor Firm N 42C Street Address 1 p y State Phone 18 Contact PersonI License No. Phone if different t 8 Owner/Agent (it different than #1 above) Business Address 9 Zip City State Phone ( 15 Describe Work: New Addition/Alteration .. Replace/Repair 7 10 Applicant Name Street Address 11 Zip City State Phone ( 8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct($) 1: / .�� '�itvliscellaneous: 10 APPLIANCE: Dryer(s): Range s): Gas Log(s): Wood Stove! Solid Fuel: Gas Water Heater(s): 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N 12 AIR HANDLING: 10,000 CFM or less: / ,= j-; ; More than 10,000 CFM: 13 REFRIG SYSTEM BTU: 1-100M: 1001-500M: 500-1000M: 14 1000-1750M: Other: Pressure Vessel (cu. t.): 15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 30-50: 50+. 16 GAS PIPING SYSTEM: Number of outlets: 17 HEATING SYSTEM: 1-100,000 BTU: 100,001 + BTU: 18 TYPE FUEL SOURCE: Electric Gas ❑ ; 011 ❑ ; Coal ❑ ; Wood ❑ ; Solar 0 19 TYPE DISTRIBUTION: Forced Air Radiant ❑ ; 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 ocal laws regulating construction or the performance of construction. SIGNATURE OF OWNER OR APPLICATION DATE—"� /r•,2