1985, 08-27 Permit App: 00007256 Water Heater*
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner' N` (Last) t) (M) Department Use Only /
�
Y '�Aat`\ c:31 C`Q `Project No. ---7,2S Y
2 Project Ad r (Not Mailing Address) Space Zip
:3S
,v 1 3 \ ....5. 1, A
3 City/Community
O _
toSubdivision/Plat
ui D
Name
4sSesso2S rPc_ar ( Ai° .
4 Assessor-Parce o.
t25 —bSo )
Lot
Block
16 Contract'm Name
Str=,=t Address
'•—• 1 Cra3 — 3 7—""- ksi Q.i
17 Zip
Cit
I State
Phone
18 Contact Person
— (
License No.
Phone If different than above
8 Owner/Agent (if different than 011 above
Business
Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New ❑ Addition/Alteration
❑
Replace/Repair
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(s):
Hood(s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
Range s):
I
Gas Log(s):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
11 UNIT HEATER(S): Wall Mount: Y N
Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or less:
More than 10,000 CFM:
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. t.):
15 COMPRESSOR/HP: Lessthan3:
3-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU:
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric ❑ ; Gas 011 0 ; Coal 0 ; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat Pump ❑
1*Number of separate zones for any heating, A/C or air handling system.
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
OWNER OR
APPLICATION
DATE g -`c275 ��
RE\31-