1987, 02-20 Permit App: 87000453 Water Heater MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE^RINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project a /11.....53
Owner's Name I First ,- MI 'f/
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Project Address(Street Name d Number)
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City state SuDdlvlelgllPlat Nag*�
tAi� 0/DK__
Nassaur.Potosi I ,,2_14'-34 0513 Lot Block !Wel r
Applicant i/. I-e. i 1 ' Address10 0 5 /0 r--1-‘,
City*
SUN. Zip Prlorw
d/iii /,v) 99 , 91S — 4,2
BwIf1.1e PnOA.
Contractor Arae«. '
- ) z1 2D -Z' 3-7D
City , si.(. ZIP
0/ A4 I -, W27 Pte. Way—//7� '
Wilms.Phone
o.wrlo.work _,0._ ' !I f4T / `Z.—` '4—
Fens Ev.por.Ilw Cooler Meow E4VIp f WM.a(PICM 1►e4101111
prYw Rang, G.s Lag GO Wider MIr. BOW Fuel/Woos)lassie. '
Air Handling Unitao-10.Ooo collo 10.000+CFM
Refrigeration Systeme/ ( 1.100M 101-600M 501-1,000M
Heat Pump!(BTU)
irereeee. 1,001-1750M T Our)7501 11 /
ComDr>t.1or ."7"..... ""4-1SMP 1 . 1§1prip u 3=0011P - !514+HP
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1-6 0uI1M�' - ...��. B+Outlets
a . )w ---1
Go Piping
(1w Fired PWsttng System 1.100,0008TU 10.,..,00+aTU
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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.
J.
SIGNATURE OF,,, eel/ 1�) APPLICATION :1-;',77e/(7
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