1986, 11-18 Permit App: 00014232 Water HeaterMECHANICAL PERMIT APPLICATION WORKSHEET
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 %" APPLICATION f�
OWNER OR __ �O DATE
Project # /tt 2.
Owner's Name Las Fi� MI
ithieil
Project Address (Street Name & Number)8;324- ii
City
State
Su ion/Plat Name
w . •�
Assessors Parcel #
25 l/ / — 10 26
Lot 33
Block s
Plat #
ApplicantQ
(Lt'
Address ;�
S • 0 0GG 4 � e t7.C1',,
City
State
/4)--/4)--9
Zip
91,9
Phone
92 f — 6.4 75_
Business Phone
Contractor -
cfC.Q%4 /�0 .//
Address
�f �%
J.4e • D/
City
z,l,n
State
Gl...16•---
Zip
992,Z6
Phone
14"91/7 '.e36701- .
csc;izLos_lixe7)(,)a,41'
License #
- Sr- .-i J' -
Business Phone
Describe Work / ��
�J I,IC�� 1iC..G(�Z1-AJ ii -,C1, -AJ
Fans
Evaporative Cooler
Hoods 7
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water
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
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
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 %" APPLICATION f�
OWNER OR __ �O DATE