1986, 09-22 Permit App: 00013226 Water HeaterMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT ?i 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.
SIGNATURE OF �APPLICATION
OWNER OR Ste,4
GLJGZGIIC_ DATE
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Project 11 /32_7_4
Owner's Name � fret - MI _
as/�
Project Address (Street Name & Number)
3 4 i
City
State 1
Subdivision/ Plat Name
Assessors Parcel ' /� / d (✓5 `
ES5Applicant
Lot
Block
Plat #
il4L...itt.„) 4
Address /
)def__)/j...
City
O l
State
GJG\__
Zip
99) ef
Phone
9�� 4.3 Va—
Business Phone
Contractor
Address
City
State
Zip
Phone /{�j, -�,y
1/74
Contact (
License #
QA _ 61 -�o'-iV'G
Business Phone
Describe Work
`;7 i4d b
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
• Dryer
Range
Gas Log
Gas Water
Solid Fuel/Wood Stove
Air Handling Units
0-10,000CFM
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
10,,,C.00+ 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.
SIGNATURE OF �APPLICATION
OWNER OR Ste,4
GLJGZGIIC_ DATE
/v4