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