1987, 10-05 Permit App 87003362 Gas PipingH
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MECHANICAL PERMIT APPLICATION WORKSHEET e.0t- x-!
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
22 /2 e.
1 Owner's Name (Last) �� (First) (M)
/�.� G/� p /4 iAl
Department Use Only
Project No.
2 Project. ddress(NotMailingAddress) Space Zip
3 City/Community
Pr tc N
State
I ii.G
Su sion/Plat Name
or23(4.) /4DO
TO O'2C—€k/A
4 Assessor Parcel No. I Lot
rags II -CJS 1
Block
26
16 Co atra//c//tpr Firm Name
Street Add. % /
17 Zip
���///
City
\ ✓2�;, ----,C -
State
/�/7,- - -
Phone
. (6.? q) �%G — g^ ...7 --'
18 Contact Person /
License No.
Phone If different than above
I
8 Owner/Anent (if different than Al above)
) Business
Addreso
9 Zip
City
State
Phone
( )
15 Describe Work:
I New 0 Addltion/Alteration 0
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/
I Solid Fuel:
Gas Water Heater(s):
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:
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. t.):
15 COMPRESSOR/HP: Lessthan3:
13-15:
I
15-30:
30-50:
150+:
16 GAS PIPING SYSTEM: Number of outlets: / 6 ' Cr
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas ; Oil 0 Coal 0 Wood 0 Solar 0
19 TYPE DISTRIBUTION: Forced Alr '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
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction. ALE
SIGNATURE OF DNIS}{R4g OF, ALLIEDHEkTING,
OWNER OR E.QS1I. TRENTAVE- APPLICATION _
a L-, - -�-�- DATE
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