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1985, 07-10 Permit App 00006371 Gas HeatingZ MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND (First) (M) Department Use Only 1 Owner's Name (Last) /71—A/Z;0<Y 'Tee?/2_ y Project No. 2 Project Address (Not Mailing Address) Space Zip / State `/t Subdivision/Plat Name iLLE`tr /57` %Oa 4 Assessor Parcel No. 051// — 1r / Lot / Block 16 ntractor Firm Name Street Address // 17 Zip 1��0 City I ��,lld,,s-'.e1N E State / ')4 Phone (501) --:-.3.--- .... = 18 Co t Person License No. Phone if different than above 8 Owner/Agent (if different th 1 above) Business Address 9 Zip City State Phone ( ) 15 Describe Work: New f, Addition/Alteration ! ; Replace/Repair 'l 10 Applicant Name Street Address 11 Zip City State Phone ( ) 8 VENT: Fan(s): Evap Cooler(s): Hood(s): f Duct(s)1: Miscellaneous: 1-10 APPLIANCE: Dryer (s): Range s): Gas Log(s): Wood Stove/ 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 COMPRESSORIHP: Less than 3: 3-15: 15-30: 30-50: 50+: 16 GAS PIPING SYSTEM: Number of outlets: 17 HEATING SYSTEM: 1-100,000 BTU: X 100,001 + BTU: 18 TYPE FUEL SOURCE: Electric ❑ ; Gas 7 ; Oil C ; Coal O ; Wood Solar 19 TYPE DISTRIBUTION: Forced Air C ; Radiant C , 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 F e / APPLICATION 0 6R���`� ���`�J �1 IlG��IU?��4/ DATE /0076-1