1985, 08-02 Permit App: 00006939 Mechanical Fixtures MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (Fiyit) (M) Department Use Only
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tr.,11JYL,�I. " /Lii,vt, (Ci Project No. (4"( / I
2 Project Address(Not Mailing Address) Space Zip
1 3 / -16-1--k, iii///
3 City/CommunityState Subdivision/Plat Name
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4 Assessor Pl No. Lot I Block
e'25Lig -- 6 11
16 Co tractor Firm Name 5`, ��� Street Address
'V + CC-1.4 A r=` / 7/6 )�— = ' ,
17 ip ,—. / ��it—, State Phon4ii,/,.4..( PL. . e
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18 Contact Person License No. Phone if different than above
AYYI a141� F %93NI
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
15 Describe World1
0 (t ILI •'2.-ti 1 �l/Z,14L //;� AvZ i.a. c.t-3 CJ, OC"' .(tiy..� LJA
r��- New` L' ,AfT on/Alteratio5v ❑ Replace/Repair 0 r,
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/
Dryer(s): Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
t— 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N
Z
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:
LL
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W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
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0 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
Z
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Cr 16 GAS PIPING SYSTEM:Number of outlets:
00
2
D 17 HEATING SYSTEM:1-100,000 BTU: 100,001+ BTU:
Z
18 TYPE FUEL SOURCE: Electric ` Gas 0 ; Oil 0 ; Coal 0 ; Wood ❑ ; Solar 0
19 TYPE DISTRIBUTION: Forced Air Radiant 0 ; 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 ) 4.4 �'j� APPLICATION /
OWNER OR i- 'L1�4/ DATE Y/.. ,-5J