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1991, 11-04 Permit App: 91007533 Mechanical Fixtures
ti. :.:ECHANICAL PERMITAPPLICATION FORM Information Worksheet JOB STREET ADDRESS: 5- ga I 1 / A `!vie Cri 9(- -7533 CITY/STATElZIP: 5 p V OWNER: I Je v m C MAILING ADDRESS: to A 't,1 a -I I� PARCEL NUMBER: PHONE NUMBER: 'ld E - 325 CONTRACTOR: f A ) P ITh (Street) C 4r bl-,K1 Cf.JfFrR MAILING ADDRESS: DESCRIPTION E. g3)D _5peo31.4e. (Street) (City/State) r� LICENSE NUMBER: t- 14I(:O &C 173 b L( PHONE NUMBER: (5og) gx.re9 / 1 ,s (Y)KAN e. 1 9920(0- ' 92o10- ' (Gp) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVEDASEf?T:±irf GAS WATER HEATER'."; :;..: ; :- - - • i' GAS EQUIPMENT<100Oo0.'BTU` NCti1DESaI' k :< GAS EQUIPMENT+100,000 BTU DUCTWOR GAS. PIPING.�El1'OUTL'tNif Xo; BOILER/REFRIG 1-100M BTU-.:.4=ti::: IL i/AEFAIG1'Y01300MlTOIEW3 "> BOILER/REFRIG 501-1,000M BTU;''=e ni. _: (; ":yBOltgR1REFAIGl1r0001i12SOM`BTUµ;:<-�-:-:;`:;__u:�;�>.;4, BOILER/REFRIG+1,750M 1EAtPUMP;$"A1RICONDIIIONER.:6433ONS _, .-',: ,._,,HEAT PUMP, &'AIR CONDITIONER 3-15 HEAT=FUMR$AIR'COND(7IONER=1,5t30=TONS;= :s HEAT PUMP:&AIR CONDITIONER 36L50 TONS;=. iEAt:PUMP47AIR CONO T/ONEF; +50 TL)NS> -: 1"' w'. VENTILATING FANS"a'_'d ;:'-:+ ;., ,' :"'°__:-::r_ el/AP<3.RATiy COOlER5m TYPE 1 HOOD (PER 12' OR 12' PTN. OF. HOOD --- CLOTHES DRYER GAS LOG :MISCELLANEOUS (NOT COVERED, ELSEWHERE ': UNLISTED GAS APPLIANCE <400,000 BTU .ULINSTED.GAS APPLIANCE>400000 USED APPLIANCE <400,000 BTU USED..APPLIANCE>400,000 BTU' AIR HANDLER <10,000 CFM AIR HANDLER>10,o00 CFM`:- r� NOTE: MINIMUM PERMIT FEE IS 535.00 SIGNATURE NUMBER OF UNITS X EACH UNIT =AMOUNT x10.00 =, - .._ -. :.. _. 25.00 : x =`. x10.00 =;_. „.1....- ,._."x X 1200 =; •:__,: -,.;::,,.;r-- - • . x15.00=...' . x,1.00'.. =: ., .:TY--: • .• •:-.....: x1200 = _ :.._�::....- .' •._ . ,,:.r.:: :x20.00 -'-.;;r_ :a;^: iej•• .-2-t‘,..._::;7. c. de t': .x25.00^ =A+. • :.3 :ti:ri:-t•-': x35.000.' ", r:_+::�. ,. -_ -r_ "x60.00 ;_ zo-.,':u•.> . . .. x 12.00;,,- -?.-1??....,-V-,1-'7'.4.--. x20.00 -- -":°;` _.... .t x 25.00::a=;. -A :aaT. r:t : a.'. x 35,00Txom:. :=�^'.'Cri":,�t .�44R.a .. -'3r: . . x60.00_ ;:: -v-+: '' r" X 10.00, _ ~_ .. ';::; .�s..- X 10.00 :; .. .:,...:'.c.:.7 - _::z:: ,.-.,,.., *50.00 =':. :.::::__--.= x 10.00. = - X 10.00 = X 10.00 = x10.00= /()- - x10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ %/ — PLUS: PROCESSING FEE + $ 25.00 EQUALS' TOTAL PERMIT / _ FEE DUE = 5 (O - _.,.tit•✓ C.