1986, 03-20 Permit App: 00010128 Water Heater MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project 0
Owner's Name Last First MI
07-77.--;)-0
Project Address(Street Name&Nu l/ ,I_
- //7� 9 //' T—.
City State Subdivision/Plat Name
e aN _Calf Plat N?�
Awes Prcel( 514 — f 4o Lot•
Applicant Address n
?/Z9-121L-71-/L-e-A_ � - // 7G /4, 1*)�.
City 1 ate Zip Phone
'Business Phone
Contracts ` Address
�'46/1-;;- - 3 /—/tvI, /2y L ., / . 7z)
City State Zip Phone
`. , /t1r- X17 f9-//?6 -S2f
Con License N Business Phone
Ii '-4vz- ` -� ,-r-- 372,u .
Describe Work
e'l
Fans Evaporative Cooler Z Electric Furnace/Ducts Miscellaneous
. Dryer Range Gas Log Gas Water Httr. 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 O-3HP 3-15HP 15-30HP 30-50HP 50+HP
1-5 Out iets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,0008TU 104., 01)+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 OF ` APPLICATION
1/41‘7'-
OWNER OR _ 1 ��,L � G�/�L If-F'. DATE