1985, 05-20 Permit App: 00005504 Water Heater . - • Ready Al)0 a)
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) 4(First 4 ( ) Department Use Only c'V
F.T ,/4 4 ` Project No. _7y J
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2 Project Address(Not Mailing Address) Space Zip
- - e9//6 - /0 h 992,00
3 City/Community State Subdivision/Plat Name
S/>o kcz.v e Lv AI grAlCiCSKO 17A 1 E' S T b f
4 Assessor Parcel No. Lot Block
16 Contractor Firm Name Street Address
K 7 of o le �S�o/C'an.e /V /3/g- M?or le_
17 Zip City State Phone
9 ,2a / Seo/.a•--•,C. w AI (s ' ) 3a6S Eao
18 Contact Person License No. Phone if different than above
41/71• A.1..Ieaa
8 Owner/Agent(if different than#1 above) Business Address //
I�ec°�,k- /V vim l/�1'6IC,'
9 Zip City State Phone
7SI2- l6 Sha Ne al (5O?) ?29--6/39' ,
15 Describe Work:
New ❑ Addition/Alteration ❑ Replace/Repair I-
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/ 5Cc4.4+•/4y(>-) /
Dryer(s): 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
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a12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
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W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M:
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W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
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O 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
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W 16 GAS PIPING SYSTEM:Number of outlets:
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2
J 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
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18 TYPE FUEL SOURCE: Electric ❑ ; Gas ❑ ; Oil ❑ ; Coal ❑ ; Wood ❑ ; Solar ❑
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 local laws regulating construction or the performance of
construction.
SIGNATURE OF . p cam, _ APPLICATION %��,�5,�--
OWNER OR I • DATE