1985, 06-05 Permit App: 00005908 Water HeaterMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
As
1700
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 a �� APPLICATION
OWNER OR LO �l41�� /X i /J/lDATE 3/tf
Project p ��j^:
�J`l L%Ci
Owner's Name 1131 First MI
Project Address (Street Name & Number 6/
A-. /C1/.,77 4 414.7,,,,./45,1
City//
r y it,it,
State �� 1 `
/4.A..
Subdivispi �(Plat Name
(JRI-WV / Tc -t
Ass ors Parcel It
U85Se/ ' o¼',
Lot
Block
Plate
Applicant
9/(/� ,// ,[/�J
Add eaa /�/ M `' 1
City / 7,/I
,17� LL�fi,
State 1
/1) -
Zip
CG70(,
Phone/
9Z,�— 4/<6
Business Phone
Contractor
� nr,r� - C/ m�
Add ess
- O - A - . 7On
City/
�� n �,
Statet. ��
Zip 2 `
Phone •�. -• -7
Contait /
.til i7/�,c--I1;Y h911/
Lice # j� -2-
—ttr—._(�—-.4ALL--
Business Phone
Describe Describe Work /�
egg-41-Otc7 - '74 i 71- /i )70,1-112 %Zti L L
Fans
Evaporative Cooler C/
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water FP r. 497L -L_
4_45e DOC
Solid Fuel/Wood Stove
Air Handling Units '1/40-10,000
CFM
10,000+ CFM
Refrigeration Systema/
Heat Pumps (BTU)
1-100M
101-500M
501-1,OOOM
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 Healing System
1-100,000BTU
10,0:00+ 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 a �� APPLICATION
OWNER OR LO �l41�� /X i /J/lDATE 3/tf