1985, 08-29 Permit App: 00007184 Mechanical Fixtures MECHANICAL PERMIT APPLICATION WORKSHEET
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PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name 1 (Last) t(First)r) �L / (M) Department Use Only ,�
I-1-1-{.� t L� %f l V 1—t .S (Kei T L7/ Project No. `�
2 Project Address(Not Mailing Addr )' J Space Zip
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3 City/Community State Subdivision/Plat Name
4 Asses i /+r Parcel No. l Lot I Block
2-4( , Ob ,-.2---- 1 1 6 l `, 1 elk s,,f. 4..5-Ke-3,---
16
sKe-316 Contractor Firm Name Street Address
A rut ('4A 1 c y f� 1 iv( !-A) o .rteD/AitiA
17 Zip?‘[. ? //, l p�J p�d State Phone
18 Contact Person f License No. Phone if different than above
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8 Owner/Agent(if different than#1 apoly
e) Business Address
de-r _/ S /< ,4-GT, : (.6/42-�lk 4 r-
9 Zip Cites State Phone
g 9,90 -' �7- rIAA , ( ) Z3g'-�.5 ,;:-1
15 Describe Work: 7
New ❑ (V Addition/Alteration ❑ Replace/Repair,
10 Applicant Name Street Address
11 Zip City State Phone
l )
* *
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: Miscellaneous:`
10 APPLIANCE: Wood Stove/ L- &-'O 4 �X–
Dryer(s): Range(s): Gas Log(s): Solid Fuel: Gas Wa er Heater(s): /4 -
410/x.
H 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
Z
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a. 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
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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.):
a
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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:
m
Cl i4CAS—t 0c) 1
2 17 HEATING SYSTEM:1-100,000 BTU: y { 100,001+ BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas ��I�lJ 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.
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SIGNATURE OF .`" --:.
OWNER OR DATE