1987, 03-19 Permit App: 87000757 Water Heater -• MECHANICAL PERMIT APPLICATION WORKSHEET
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PLEASE'PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Owner Name --vel ����.LtX Y�,c�f�. FI�. Q t l
, Project Address(Street Nam.&Nr_____
umb.rl / U L� ,
City stele SubdlvlsloltlPal Name
lidAti �Ze c� n1 kf Qori E' f. N o . 5 P--
Aur.roN I OI ��J• ' Lot 2 1 block 3 tail
Applicant A Addr.us
g- A . -79?ci- 6ouLatt)— .
City Stat. Lp Phone
F 42.A./P-47.e .,, ((.1%--- 99Aa
Minus Phone
c.o.d. / Address
,3e-a — , ?o-8. 37O 7
City Sat Dp Phone
,D Z mezzo 4 ---//77) -O
Contact Uounee. tlolnsss Pitons
— g -.3 7, 1-
DeeUr1I»work
iris - 7411 ,// 71-(14
Fans Eyewink,*Cooler Hoods fyrn fpolQuc4
11Mt1qPII
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Dsler Rang, UN LAIg GO Witter HU. -1plid fu.Il Wi.od law '
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Alt hlsrt4,lrtg UMW 0.10,000Cf M 10,000+CFM
1•100M 101.600M 501-1,0001
Hoar Pumps(BTU)
1,021.17501.4 F OwSI1750M
Comprrlot P ' MiirlP .a _ 14i GHi' F •**GIP{
`► V -- -6 1Qttlld.s i r , 1+ --- S.0111INs T
G Piping
004 Fluid Hosting OyotMn 1•100,Omb1IJ ° 10.000•BTU .
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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.
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SIGNATURE OF �� (1,4i/AT? // // li/� APPLICATION c5/9/17