1985, 07-10 Permit App: 00006479 Water HeaterXo'/
MECHANICAL PERMIT APPLICATION WORKSHEET /goo°
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 ,--/VrS /v/7�/ke—
APPLICATION
DATE
74/7s
Project') ti`7�i
C9 L ``ll
Owner's Name • Last First - - MI
7.70D 1/1- /./ 1,12,/ 4 nn.tJ
Project Address (Street Name & Number
City
State
Subdl on/Plat Name
(jR/i/JDV(&v 11ci s /ST
Assessors Parcel dr�Y�,_ 7
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Lot /
Block (//
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Applicant i� �///�v
Address
7 /-^ {/n ,'n/,y/J
City
State
Zip
Phone
f
Business
Phone
Contractor Z
..-12.0,4z — ,tie n�
Add ess
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City
7/1.��/� �
State/
LC�f�
Zip
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Phone
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' Contact / /
9Y)tol9A-77,� Din;
Llcens§M
G0-CU✓-.G.Z — 1,7,-1--"A--
--Describe
Business
Phone
Describe Wark gift �K " /2 7-bi ck-7 /th-A' -/-47-'7C-A----
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Fans
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water
,gii
Htr.
/)lid) f//t
Solid Fuel/ Wood Stove
Air Handling Units
0.10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M •
Over1750M
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
100,;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 ,--/VrS /v/7�/ke—
APPLICATION
DATE
74/7s