1986, 10-08 Permit App: 00013604 Water Heater1
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT 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 OFG��`%�/���
OWNER OR ��
APPLICATION / C//a77e-j
DATE
Project 0i 3lob€A
Owner's Name Last,_ First MI
Project Address (Street NameL. Number zo
COL'fr
°
de it
State
2 -0-
Subdivision/ Plat Name %/�l �
V t STA— L9y4R0ELIS (I—
• sors Parcel p 6/51/4-4— 02-3 44
Lot t
o
Block
2
PI aKK
/ /eon
Applicant ,
Address
City
State
Zip
Phone
Business Phone
Contractor
rt)'fd 75. /r 7e_,
qesy
r s, 7
City /
State ey
�/ /
Phone -_
? 7.
Co) act /
License 0
Business Phone_
/
Describe Work
�t/! z.x.,ac'%ri/- ✓./4a
Fans Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer Range
Gas Log
Gas Water Fitt-.
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
1Q,,,: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 OFG��`%�/���
OWNER OR ��
APPLICATION / C//a77e-j
DATE