Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
1986, 03-10 Permit App: 0011002 Mechanical Fixtures
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 Project No. � 2 Project Address (Not Mailing Address) �l� [ Space Zip I--- F'/�/ % is.'. ef �/1/HNUe/f- 3 City/CommunityState po a<4.� I - Subdivision/Plat Name c:x s L wi LA -5 pICO i11orJ 4 Assessor Parcel No. z -g 51 ) - 0213 Lot 13 1 Block (� 16 Contractor Firm Name Jt./c-oaf Street Addre s �7,t=7�,-7 17 Zip 7/�J v City pe,' 4- pe,' `-u— State l,vp Phone ( ) r zec--oy7 18 Contact Person License No. Phone if different than above 8 Owner/Agent (if different than #1 above)Busines IA 6,7 ©r (u d0i' e above), L.,,, d- £�7`_.5 /.tea/7.? > Address a %/ y 9 Zip I City ( State I Phone ) 15 Describe Work: New ❑ Addition/Alteration k Replace/Repair 0 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: Dryer(s): I Range s): Gas Log(s): Wood Stove/ Solid Fuel: Gas Water Heater(s): r -� 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM: I 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M: 14 1000-1750M: Other: Pressure Vessel (cu. 1.): 15 COMPRESSOR/HP: Less than 3: 3-15: 15-30: 30-50: 50+: 16 GAS PIPING SYSTEM: Number of outlets: .. 17 HEATING SYSTEM: 1-100,000 BTU: 100,001 + BTU: f/ 18 TYPE FUEL SOURCE: Electric ❑ ; Gas 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. SIGNATURE OF OWNER l APPLICATION DATE 246°' 15,