1985, 04-30 Permit App: 00005235 Water HeaterMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1
As
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 '-) APPLICATION 47
(p
OWNER OR /,f/ DATE g6
Project # 5235
Owner's Name FI t I MI
.&L
Project Address (Street Name & Number)
1 i 9 3 . petAL-776L_
City
State ``'
Subdiv nlPlat Ne lii ,f/is
rs ParcQl 5P} / h)
Lot 21
Block /
Plat #
Applican1 41
Address e) 5 . Petisk )260.
City /3 _.
State
&Ai
Zipfl a"j�
Phone ' 3z,_
v
Business Phone
Contr or
6a — (/d e J
Address% f�
A. . 87,o i
City
D i��
State
1c�a
Zip
99e)Cont
Phone 41Y �/74 _!
J//{�
6 S
License #
VVI —Se 701/IA--
Business Phone
l
Describe Work —01.d.
'' 1/,,e_74 1
Fans
Evaporative ler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gae Log — —
Gas Water Htr.
3 6r.C,
Solid Fuel/Wood Stove
Air Handling Units
0-10,000CFM
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
30-5OHP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10u0;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 '-) APPLICATION 47
(p
OWNER OR /,f/ DATE g6