1984, 10-22 Permit App: 00003059 Mechanical Fixture •
MECHANICAL PERMIT APPLICATION WORKSHEET *T
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M) Department Use Only '29-1 -1,
,w,.2 11/. 4 t"�`,lt • Project No. I
W-...4--2 Project A Jess(Not Mailing Address) ' C2Space Zip
N . /t -7c `7— / X '-2- fy -c
3 City/Community State Subdivision/Plat Name
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4 Assessor rcel No.
2434o) Lot Block
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16 ContrCStreet Address
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17 Zip ity _._ State Phone
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18 Contact Person / 1E-NZ
se No. Phone if different than above
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8 Owner/Ag t(if different than#1 above) Busir(ss Address n ,
eN v _ - J-5-.T
9 Zip V City State Phone /�
15 Describe Work:
New X Addition/Alteration ❑ Replace/Repair ❑
10 Applicant Name " Street Address
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11 Zip City State Phone
( )
* ,
8 VENT: Fan(s): Evap Cooler(s): Hood(s): Duct(s)1: X Miscellaneous: ..*,,It
10 APPLIANCE: Wood Stove/ / \ 3�—-3'�.,-
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
W
2
EL 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM:
5
Cf
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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CI15 COMPRESSOR/HP: Lessthan3: 1 3-15: 15-30: 30-50: 50+:
Z f
Q
W 16 GAS PIPING SYSTEM:Number of outlets:
CO
2
D 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
Z
18 TYPE FUEL SOURCE: Electric; Gas 0 ; 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(,-...,' APPLICATION _
OWNER OR -C_ �kw,l, 4....1.}.,.�.�.0I , DATE- /O ai- i -f `-