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1989, 01-26 Permit App: 89000168 Water Heater t -^— �-- _..,. ! t.x=:'`i ea' ''- _: .-,,,,,„-e.:ri.. d ?. ,'.:3 ;_»; 7v,'... t,'_.--:,9P. - .. ... 4'' �-. .. Y„r � . _.. �_ �".-. ' . ,,- -... � _ '�` � ..... Via.« ...; MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND AS Project 0 � _—/CSS Owner's Name i Last ca:First 2 L.... MI 4,_ Lo ki Project Address(Street Name&Number) N `-t o Z L) .. /2-€9 __ CI State ASubdivision/Plat Name ( - Assesso anal# /7 S i./// /,�„ `� Lot Block Plat# plicant / �7`/O Address , CN-41,C--‹ ot 22-—.T-'1,-N.. ,atzsa..........._ State Zip Phone 452-o L 6iiiaZ Business Phone -)1,..,4H-P -44 Si Contractor Address City State Zip Phone y t t LI nee N Business Phone C i9->St3" Bilicb It CS z_ aiZ2 - Describe Wor 1 'q' Fans _ Evaporative Cooler idiDods 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/ 1-100M 101-500M 501-1,000M Heat Pumps(BTU) 1,001-1750M Over 1750M Compressor 0-3HP 3-151-11, 15-301-IP 30-50HP 50+HP 1-5 Out 6+Outlets Gas Piping Gas Fired Heating System 1-100,000BTU 10v,.A0+BTU: ...v v s 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. res‘ .i --- --g 5 SICMIATI IRF nF )4-4:1-A.--t APP( (CATION / 23