1986, 10-15 Permit App: 00013773 Water HeaterMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
/2-0
AGsu t3
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
-4. CJI
APPLICATION
DATE
X/5-4
Project# 00713
Owner's Name Last Firm MI
C:4f1-. c1� e_ ...,„hr
Project Address (Street Name & Number �/�
,2O /O -79.4(!U•.,G
City
State
Subdivision/Plat Name
PPorr# a,I-Ty
Assessors Parcel #
0$5't3- 0174
Lot
Block
Plat #
Applicant/////�//,,�� ���-� ,
Add ess
c/a/O1--��'//
City
�
State
`C,--
Zlp
Phone
? —00,3(C
/ /
Business
Phone
Contractor
Address
•7C g 37
•
7
City1 State
e iX g-Zel. /4)617._-992-2-0
Zip
Phone
9 7/70 tpe
Contact /
)nL D.g9zo-
License#
�_&y- .fir "d3 7,2A/8
Business
Phone .
Describe Work A ,,,, //J�
Fans
Evaporative Cooter
Hoods (7
Electric Furnace/Ducts
Miscellaneous
Dryer
3
Range
Gas Log
Gas Water
i,�, ✓y"-'10,000+CFM
Htr.
Solid Fuel/Wood Stove
Alr Handling Units
0-10,000CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0 -31 -IP
3-151-07
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
5+ Outlets
Gas Fired Heating System
1-100,000BTU
1P,,;AO+B7U
r
fl1 EE V
' Itl
` J
1
(` 11� e V E I V E
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
-4. CJI
APPLICATION
DATE
X/5-4