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1985, 07-10 Permit App: 00006501 Water Heater• MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Q6a' 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 conn 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 524a - &,,e(A) APPLICATION DATE /0_6 Project# AS?) Owner's Name ����L]]ast rst MI _ ) 7 _ G Project Address (Street Name & Number) City State Subdivision/ Plat Name E1-420- EEA A/n&�s Assessors ParcelM / 7 z 3 Lot 10 Block Z Plat # Applicant Address k--. 1,19/ City 1i/%e i Statte� LCA-= Zip / f7 Zik _ Phone ��l �r , j — al � X17` JJJ / Business Phone Contractor.424-1162---• c-eiet/Cia-- - d- Address •®. 4 . 3727 City State Zip Phone 4 Contact �r� OYt G L�/ LloenseN -air- ,7T Business Phone /�,, �,��, lam✓ G�..r/v f."'�� Describe Work /4)71— Fans Evaporative Cooler Hoods Electric Furnace/ Ducts Miscellaneous Dryer Range Gas Log Gas Wa Htr. 3 o 8/7A- Solid Fuel/Wood Stove Air Handling Units .0,000 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 0+ Outlets Gas Fired Heating System 1-100,000BTU 10u,;;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 conn 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 524a - &,,e(A) APPLICATION DATE /0_6