1986, 10-28 Permit App: 00013936 Water HeaterMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
`.
Project # 451sk
Owner's Name Last/�?FI t MI
,c,/,-'&42 /' U,iV/t.`'�i
Project Address (Street Name & Number)
6- . 7719 .1jeket.4-151-
City
146.41 i ,
State )
/V�_
Subdiv n/Plat Name
URC µ A go A VEIuGc£
Assessors Pa cel #
66-57/g - 2 bq
Lot
Cl
Block
'da--
Plat # AS
23511-y
Applicant/ -
Address /VCity
I 3416—
//
*-44144.t) ,
State _.
•..._.
Zip
q902-) ----
Phone
14' --.32-0
Business Phone
ContractorAddress
i
.� - ,0.� —1/
,---)
r'°-46 - 3761
City
• 0 ,, ,
State C/
1,() -
Zip
9922
Phone
1-/17 `f 2 6.
Contact
1 1de927 ?-
License #
l- --.37.2-/iii-
Business Phone
{ Describe Work �/.ill 6i -n- /J a_._
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr. /
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM
10,000+8/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
30-5OHP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-t00,000BTU
10.0;00+BTU
EC I V E
OCT 2 81986
i
I certify that the above information as submitted by me is true and creef, wr all pro-
visions of laws and ordinances governing this type of work, including inspection requirement , e 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
OWNER OR
Vxejtz4 f, i0
APPLICATION
UJ DATE
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