1986, 01-29 Permit App: 00009586 Water HeaterMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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.
OWNER OR
SIGNATURE OF �J� /f�/ DATE
APPLICATION /2q/(14/2q/(14/,(LZ2 — L�Lfi r //I /Jell
Project If
Owner's Namee�st� First MI
±a42- -(—S le nl v_n J
Project Address (Street Name & Number)
6- '�3 24,J,Ar,r�4}
CitySlate
Subdivision/ Plat Name
Assess s Parcel a
Lot_ _,
Block
Plat a
Applicant/
ia�-n l o-Ff s
Add in
E - in:,7..s LAA:c',Ai
City
44 // 4 yuz
State
/tel—,
Zip
#.2-/2.--
Phone
%a2. 41 -34,,79
Business Phone
Contractor
Address
City
State G
Zip
Zip 9'Q.
/ffq-47D
ContEy / -
License #
Business Phone
Describe Work
-6- JGZ2
f -Bzc. ,'itt� ua��
Fans
Evaporative ler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr. / v
0 Ce
Solid Fuel/ Wood Stove
Air Handling Units
0-10,000CFM
10,0303+CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP .
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
/Ou,:0O+BTU
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.
OWNER OR
SIGNATURE OF �J� /f�/ DATE
APPLICATION /2q/(14/2q/(14/,(LZ2 — L�Lfi r //I /Jell