1987, 05-21 Permit App: 87001600 Water Heater, Piping .,.
- . MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Project# t �3r (/�/ e
)
Owner's Name Last First MI
} Lid DEESOAi T/0
Project Address(Street Name&Number)
.----- i ,3lel i .
City State Subdivisi Plat Name
t kif ki' 6VA p � ,-- 'Ws
Assess Parcel# 1_2_544_
'-_c_744_ ......_,2.1.._41/542- Lot Block Plat#
Applicant Address
Al C- , & /360, - %
City StateZip Phone
9 � 16 7aq-- 5-7 ?
Business Phone
Contr for 4-eo.Z.1/"46 1'�et—et-" . ` Addr ( c- 7/0 -� -��iq
City l St� Zip Phone
' 1ll ?Q2i6 ? ?— a `0Q
Con ttf
- 1 License# Business Phone
ik'iQuA14G 93 A) r _
frbeWk ehyflA44-4 -e_.`r- .( tt,( C rMQ A- .e e Gia- 1c kca.--ee
Fans Evaporative Cooler Hoods / Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. - Solid Fuel/Wood Stove
Air Handling Units 0-10,000CFM 10,000+CFM
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
Gas Piping
T r 1-5 Outlets 6+Outlets
�Z �'i
sr 1-100,000BTU 10,,,:00+BTU
Gas Fired Heating Sys m i •- I ,
� , /- S 0I /6- 60
//. 6'
GCv
3.0 0
. 0
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 OF 7'? ii1i / APPLICATION3-1- �J - g. 7
OWNER OR �� .DATE