1986, 11-14 Permit App: 00014236 Water Heateri %f
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAN
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I certify that the above information as submitted by me is true and correct and further, agree that II pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will b com-
plied with whether specified herein or not. The granting of a permit does not presume to give auth rity to
violate or cancel the provisions of any state of local laws regulating construction or the perform-nce of
construction.
SIGNATURE OF
OWNER OR
APPLICATION 7/
DATE
1/4
Project /.4/286
First ' MI
Owner's Name Last (F !
/
A
Project Address (Street Name A Number)
1) 6,„2.3 .F .\12te-c-->
City
4l k.
State
/06--
Subdivision/ Plat Name
Adt RAeEAci 'value/
Assessor Parcel N005I/ I — 651 3
! J
Lot , 3
Block -5
Plat k
Applicant
�t/d .Lc eE
Add ess ®�
/l 3 F.-.i`zewe---)
City
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StateZ612-4
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G/
Phone *-z - OS/ _5 S7
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Business Phone f�5_ 5777 77
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Contractor
Address
City a
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State
/.0G._
Zip f°'
q24�
Phone�
G �9//
Con . t
_- PI& / f /Mr c2.-)
License a
j_V -41-5f ,57an/%
Business Phone
Describe Work �,��/�f�////) W,, `1
Fans
Evaporative Cooler (
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas WaterH, tr.
`�/`�1000
Solid Fuel/Wood
Stove
Air Handling Units
0-10,000 CFM
0,00+, 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
1-100,00OBTU
10,,,x00+BTU
I certify that the above information as submitted by me is true and correct and further, agree that II pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will b com-
plied with whether specified herein or not. The granting of a permit does not presume to give auth rity to
violate or cancel the provisions of any state of local laws regulating construction or the perform-nce of
construction.
SIGNATURE OF
OWNER OR
APPLICATION 7/
DATE
1/4