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1986, 07-01 Permit App: 00011989 Water Heater J ii MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND /T)(Pei ^g -' Pro)ect M Owner's Name Last First t11 I'qA9 Project Address(Street Name&Number) /2-/U Y ..6 ,'-� 3 City State /Subdivision/Plat Name --le)/ -11--e/ -- IIILL vir, EST Assessors cel N Lot Block Plat N 27543 - �J©� 2 -O -7 Applicant �� !!J t�LC _ ?ALL -C_ ., Address . /,7o f � s /.,.f['wCity / State Zip Phone Business Phone Contractor Address &'Xilei — --726,c,/-1,,,Afi—ek,e e_1 -g. i g`7_ 2 City State , I Zip Phone ✓ `✓j�j _ed 7/._.Con / - License/ Business Phone Describe Work ! ; -41,74Z // . / 6-GC% fir,,,_ 6c,_, (�z)--,„ -t 2e.. Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove 0-10,000 CFM 10,000+CFM Air Handling Units Refrigeration Systems/ 1-103M 101-500M 501-1,000M Heat Pumps(BTU) 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 1530HP 30-50H i. 50+HP 1-5 Outlets 6+Outlets Gas Piping Gas Fired Heating System 1-100,000BTU 10v,,A0+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 OFLnif/ l APPLICATION W/ tt OWNER OR ' Cz � - ' " -f t -'- 1 DATE