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1985, 07-29 Permit App 00006852 Wtr Htr• 59 MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Project # (5 Owner's Name Last - First MI - ysfy 7i/32, Project Address (Street Name & Number) , vZZ / j), /Cr,k7r%). City'==� State Subdivision/Plat Name Assessors Parcel# /�� l (fC �> ✓ Lot Block Plat # Applican /.^ , 0A � Add ess , /fGa % .,--- .5wc_./ 4 City State Zip �� n 7Phone 7 Business Phone Contractor Address City State Zip Phone Contact II License # iA"/2 a - i 1 / , - 1-9 Business Phone rlbe Wo ;ve-(1,--,7,e7 ,...7-‘,24.ne.ice„,... 17,-.4p, 4:.,...z....ii.7.1,9,74.-- A.:,...,e. ,ezi_ ,A.e. d5r. 6,„,e,,m,„zel deb". Fans �' Evaporative CoOler Hoods EI t Puce/Duh Mi I nexus • /LLB `T-50 Dryer Range Gas Log Gas Water Htr. /ez Solid Fuel/Wood Stove Air Handling Units 0-10,000 CFM 10,000+ CFM Refrigeration Systems/ Heat Pumps (BTU) 1-100M Vo 101-500M 501-1,000M 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+ HP Gas Piping 1-5Outlets 0 6+ Outlets Gas Fired Heating System 1-100,000BTU 10,,,;,00+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 Taws regulating construction or the performance of construction. SIGNATURE OF OWNER OR APPLICATION DATE —7— 2