1989, 01-26 Permit App: 89000168 Water Heater t
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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
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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:
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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. res‘ .i --- --g 5
SICMIATI IRF nF )4-4:1-A.--t APP( (CATION / 23