1984, 07-27 Permit App: 00001494 Heat Exchanger w
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) First) (M) Department Use Only -
�/ C,JQ y-'S 0 Project No. si
2 Project Address(Not Mailing Address) ComSpace Zip
/Jt 1S c• 01-5 _ 2? -4 to
3 City/Community State , Subdivision/Plat Name
4 Assesso Parcel No. Lot I Block
16 Co rector Firm Name S t Address
17 Zip Cit / State Phone
?7d--0 G C ti0 ( )
18 Contact Person LI :nse No. Phone If different than above
�r - l A .i, .2-S'"`2/x
8 Owner/Agent(if different than 41 above Business Address
h•--b---4 r„_,o . ems. &A-a- (AS. 3v a
9 Zip City State Phone
it41:760.4.4-40....._ 0.....L..." ( )
15 Describe Work:
New q Addition/Alteration 0 Replace/Repair 0
10 Applicant Name Street Address
S -k. -. G.J1 '`lcl)
11 Zip City State Phone
( )
* *
8 VENT: Fan(s): EvapCooler(s): Hood(s): Duct(s)1: Miscellaneous
10 APPLIANCE: I Wood Stove/
Dryer(s): I Range(s): Gas Log(s): Solid Fuel: Gas Water Heater(s):
Z 11 UNITHEATER(S): Wail Mount: Y N Floor: Y N Suspended: V N
W
a 12 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:
W
0 .,
W 14 1000-1750M: Other: Pressure Vessel(cu.ft.):
W
›-
I-
0 I-
0 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+:
Z
Q
W
16 GAS PIPING SYSTEM:Number of outlets:
00
2
I 17 HEATING SYSTEM:1-100,000 BTU: 100,001+BTU:
Z
18 TYPE FUEL SOURCE: Electric y.4; Gas ❑ ; Oil 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; 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
I violate or cancel the provisions of any state of local laws regulating construction_ or the performance of
construction.
SIGNATURE OFAPPLICATION
OWNER OR c -cQ * *.0.!s-• .DATE 7— 1-7�Y