1984, 10-23 Permit App 00003093 Wtr HtrMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
First)
(M)
Department Use Only -
Project No.
1 Owner's Name(
2 Project Address (Not Mailing Address)
SpaceZip
G /-
Slate
Subdivision/ NN1ame
3 CitylCommunity
/Pratt
^ UI IV
4 Assessor Parcel No. � � � \
Lot
Block
16 Contractor Firm Name
Street tlress
o,
17 Zip
City q
State
Phone
18 Contact Person
License No.
Phone If different than above
—71
8 Owner/Agent(it different than M1 above)
Business Address
9 Zip
City
State
Phone
( 1
15 Describe Work:
New ❑ Addition/Alteration ❑ Replace/Repair
10 Appli nt Name /
Street Address
City
State 1
Phone °�L`ff
11 Zip
8 VENT: cents):
Evap Cooler(s):
Hood(s): Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Wood Stove/p—
Dryer(s):
Range(s):
Gas Log(s):
Solid Fuel:
Gas Water Heater(s): .1{�
- 11 UNIT HEATER(S): Wali Mount: Y N -
Floor: Y N
Suspended: Y N
J
12 AIR HANDLING: 10,000CFM or less:
More than 10,000 CFM:
! 13 REFRIG SYSTEM BTU: 1-100M:
100-5IbM:
500.1000M:
! 14 1000-1750M:
Other:
Pressure Vessel (cu. It.):
Law
15 COMPRESSOR/HP: Lethan 3:
3-15:
15-30:
30-50:
50+:
L
U 16 GAS PIPING SYSTEM: Number of outlets:
g
) 17 HEATING SYSTEM: 1-100,000 BTU:
a
100,001+BTU:
18 TYPEFUELSOURCE: Electric ❑ Gas Q
Oil ❑ Coal ❑ Wood ❑ Solar ❑
19 TYPE DISTRIBUTION: Forced Air ❑ Radiant ❑ Heat Pump El
1' Number of separate zones for any heating, AIC 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 APPLICATION
OWNER OR - DATE