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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 5 , 7 /c----- 71 U n Pmt , r---' / \CityState - -r(.a -, l to _ NI � 'Subdivision /Plat Name seta_seta_i(o- 1-t \ate- V t e w 6''f,tTs' S -,/ A'saessore Parcel pZZ SY 3 'l, lO T Lot 1 b Block S p Plat Applicant nr/7f 4�7-1/<5 Add ess _ V`e 4tz7 C-3 767 , ity Stat/e ) 7�pG Phone , -- y ` tel./ 1 1 Business Phone Contractor Add cies City -/ 4),: (�r. ic-e, State / "It? Zip ) 7D -)z) Phone �/,�Fe) --4'7A 1)(7-.2Ca p niact , OA AA f - n.a—s,�. ' License # „2..23_-r) / -3F A�S,C 37at, Business Phone / i— /7-.ii2-// i cif - '-'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