1985, 08-19 Permit App: 00007190 Water HeaterMECHANICAL 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 OF
OWNER OR
C
APPLICATION
-"DATE
Project p J / elO
Owner's NameLest FI a .� MI
r)2c(iirelt -4)r 1 A. 1-)4:, k.'iti—
. Project Address (Street Name & Number)
1
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'Subdivision /Plat Name
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-,/ A'saessore Parcel pZZ SY 3 'l, lO
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Lot 1 b
Block S
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Plat
Applicant
nr/7f 4�7-1/<5
Add ess _
V`e 4tz7 C-3 767 ,
ity
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Phone , -- y
` tel./
1 1
Business Phone
Contractor
Add cies
City
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4),: (�r. ic-e,
State
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Zip )
7D -)z)
Phone
�/,�Fe) --4'7A 1)(7-.2Ca
p niact
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License #
„2..23_-r) / -3F A�S,C 37at,
Business Phone /
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'-'I Describe Work
CAIt&c&, »,.,,F /IA( 141.)
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Wate H!r.
4e/ OC/1\
Solid Fuel/ Wood Stove
Alr Handling Units
0-10,000 CFM
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
10.,;.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
OWNER OR
C
APPLICATION
-"DATE