1989, 05-05 Permit App: 89001229 Mechanical FixturesMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First)/�/1 (M) Department Use Only
C K� A) 5 0 N P/ 1� Project No.
2 Project Address (Not Mailing Address) Space Zip
3 City/Community State Subdivisio lat Name
r'
4 Assessor Parcel No. Lot Block
16 Contractor Firm Name
C L��ifJ CSO "
17 ZIP City
18 Coon I License No.
8 Owner/Agent (if different than N1 above)
9 Zip City
15 Describe Work:
New ❑ Addlti
10 Applicant Name
11 Zip City
8 VENT: Fan(s): EvapCooler(s):
10 APPLIANCE:
Dryer (s): Range(s): Gas Log(s):
11 UNIT HEATER(S): Wall Mount: Y N
Z
W
2- 12 AIR HANDLING: 10,000 CFM or less:
D
W 13 REFRIG SYSTEM BTU: 1-100M: 100-500M:
t
D
1J 14 1000-1750M: Other:
1
l
15 COMPRESSOR/HP: Less than 3: i 3
Q
i
L16 GAS PIPING SYSTEM: Number of outlets:
n
> 17 HEATING SYSTEM: 1-100,000 BTU: —
Z
18 TYPEFUELSOURCE: Electric El; Gass ❑
19 TYPE DISTRIBUTION: Forced Air ❑ ;
Street Address
State Phone
Phone if different than above
usiness Address
State Phone
on/Alteration ❑ Replace/Repair F_-�
Street Address
State Phone
( )
ood(s): Duct(s) L ' i• Miscellaneous:
Wood Stove/
Solid Fuel: Gas Water Heater(s):
Floor: Y N Suspended: Y N
More than 10,000 CFM:
500-1 000M :
Pressure Vessel (cu. ft.):
5: 15-30: 30-50: 50 +:
Oil ❑ ;
Radiant ❑ ;
100,001 + BTU:
Coal ❑ Wood ❑ Solar
Heat Pump❑
1' Number of separate zones for any heating, AIC or air handling system.
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 APPLICATION
OWNER OR DATE