1985, 06-13 Permit App: 00006002 Water HeaterMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
OIVOS
Sea OG /
Project# LL1,12
Owner's Name dl ea` Firotc��, Mir) qg�/2
Project Address (Street Name & Number)
City
State
Subdivislo at Name
i 11-4-R 0 i g -m o e A-04,
Assessors Parcel flD 0� — 0 1 � l� ` c.o. i
jvp
Lot
Block Plat M
Applicant
.f.tize,c,i-,33d
Address
9 �. ,&<a� M
City
4fie �
State
/ia -'
Zip,Phone
/L
91/— ‘0 2
Business Phone
Contractor (
Address A
'740
City
�,K/a�c.e,,
State I
�-
Zip
9192-6/9--ii77
Phone
Contact / /_._
,n, 'Z,ti,L�'a ,.
License #
Business Phone
'-(N t "12-7 2,1
Describe Work p / /1
/_.Gfi f 6�CL-� — j�iIC-/%�--
Fans
Evaporative
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr. 7
(�as7LIte-- . zi 000
Solid Fuel/Wood Stove
Air Handling Unita
0-10,000 CFM
10,000+ 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
10v,.300+ BTU
y µYS
1 +
I; certify thatt`re'above li submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances ging this type of work, including inspection requirements, will be com-
plied with whether specified herein orfnot. The granting of a permit does not presume to give authority to
violate or cancel the provisions ofsty,state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
APPLICATION V3/1DATE